hmo illinois, blue advantage hmo and blue precision ...50356 surgicenter 04/01/05 center for...

A Division of Healthcare Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association

Appendix D

HMO Illinois, Blue Advantage HMO and Blue Precision Contracted Providers

Ambulatory Surgicenters …………………………………………………………. 2 Durable Medical Equipment ……………………………………………………… 8 Durable Medical Equipment Blue Precision …………………………………… 18 Home Health Care ………………………………………………………………… 21 Home Infusion …………………………………………………………………….. 35 Hospice Facilities …………………………………………………………………. 37 Inpatient - Metro Hospitals ……………………………………………………….. 42 Inpatient - Boarder State Market Hospitals ……………………………………… 46 Long Term Acute Care ……………………………………………………………. 49 Mental Health IOP/PHP …………………………………………………………… 50 Orthotic & Prosthetic ……………………………………………………………… 51 Orthotic & Prosthetic Blue Precision……………………………………………….57 Hospital Based Outpatient Surgery Class I Providers …………………………………………………………. 59 Class II Providers ……………………………………………………….... 63 Renal Dialysis …………………………………………………………………….. 65 Skilled Nursing Facilities ………………………………………………………… 76 Substance Use Disorder ………………………………………………………….. 83

Provider #

Provider Type

Effective Date Cancel Date Provider Name Class

Day Charge Address City State Zip Telephone

Change Code

Change Date

1514 Surgicenter 03/08/06 25 East Same Day Surgicenter I 1 25 E. Washington Street Chicago IL 60602-1708 (312) 726-3329 R 10/16/071533 Surgicenter 02/01/99 900 N. Michigan Surgical Ctr. LLC I 1 60 E. Delaware Place Chicago IL 60611-1495 (312) 440-5152 A 12/01/99

50213 Surgicenter 05/01/03 Aanchor Health Center, Ltd. I 1 1186 Roosevelt Road Glen Ellyn IL 60137 (630) 495-4400 A 09/11/03591 Surgicenter 01/01/98 Access Health Center I 1 1700 75th Street Downers Grove IL 60516 (630) 964-0000

1546 Surgicenter 04/16/01 ACU Health Center, Ltd I 1 736 N. York Road Hinsdale IL 60521 (630) 794-0645 P 05/01/0151949 Surgicenter 09/01/12 Advanced Ambulatory Surg Center Inc. I 1 2333 N Harlem Ave. Chicago IL 60707-2718 (773) 637-1700 A 10/01/12

1535 Surgicenter 06/01/99 Advantage Health Care, Ltd. I 1 203 E. Irving Park Road Woodale IL 60191 (630) 595-1515 A 09/01/9952076 Surgicenter 06/01/13 Aiden Center For Day Surgery LLC I 1 1580 W Lake St. Addison IL 60101-1171 (630) 285-7000 A 08/01/1351441 Surgicenter 10/23/09 01/01/13 Aiden Center for Day Surgery LLC I 1 1580 W Lake ST Addison IL 60101-1171 (630) 928-1048 C 01/01/1350195 Surgicenter 04/01/03 Algonquin Road Surgery Center, LLC I 1 2550 Algonquin Lake in the Hill IL 60156 (847) 458-1246 A 07/10/0351522 Surgicenter 04/01/10 Ambulatory Surgicenter of Downers Grove I 1 4344 Main St. Downers Grove IL 60515-2869 (630) 322-9451 A 04/01/1056363 Surgicenter 01/01/14 American Medical Center I 1 110 S River Road Des Plaines IL 60016-3440 (847) 294-9614 N 05/01/14

523 Surgicenter 07/01/08 Amsurg Surgery Center I 1 998 129th Infantry Dr. Joliet IL 60435 (815) 744-3000 R 02/01/1051442 Surgicenter 10/23/09 01/01/13 Ashton Surgical Center Inc I 1 1800 McDonough Road Hoffman Estates IL 60192-4524 (630) 928-1048 C 01/01/1352077 Surgicenter 06/01/13 Ashton Surgical Center Inc I 1 1800 McDonough Road Hoffman Estates IL 60192-4524 (847) 742-7272 A 08/01/13

613 Surgicenter 04/08/13 Bel-Clair Ambulatory Surgery I 1 325 W. Lincoln St. Belleville IL 62220-1921 (618) 235-2299 A 09/01/13513 Surgicenter 01/01/14 Belleville Surgery Center I 1 28 N. 64th Street Belleville IL 62223 3808 (618) 398-5705 A 08/01/14

51042 Surgicenter 05/01/08 Belmont/Harlem Surgery Center, LLC I 1 3101 North Harlem Chicago IL 60634 (773) 889-2000 A 11/01/0850181 Surgicenter 04/01/03 Bloomington Normal Health Surgery Ct. I 1 2100 Ft. Jesse Road Normal IL 61761 (309) 834-4000 A 09/11/0351991 Surgicenter 11/01/12 Cadence Ambulatory Surgery Center, LLC I 1 27650 Ferry Road Warrenville IL 60555-3846 (630) 225-2700 PN 01/01/1351684 Surgicenter 01/01/11 Carle Surgicenter LLC I 1 1702 S Mattis Champaign IL 61821-5469 (217) 326-2030 A 03/01/1151034 Surgicenter 11/01/08 Castle Surgicenter, LLC d/b/a HWOV, LLC I 1 2111 Ogden Ave. Aurora IL 60504 (630) 978-3800 A 12/01/0851997 Surgicenter 09/01/12 Center for Ambulatory Surgery at Swedish I 1 5215 N. California Ave Chicago IL 60625-3513 (773) 649-5470 A 01/01/1350356 Surgicenter 04/01/05 Center for Digestive Health I 1 1615 N. Convent Street Boubonnais IL 60914 (815) 936-1700 A 08/03/0550598 Surgicenter 03/12/07 Center for Health Ambulatory I 1 8800 N. Route 91 Peoria Il 61615 (309) 683-4807 A 10/16/07

551 Surgicenter 04/01/98 Center for Orthopedic Medicine I 1 2502 B. East Empire Bloomington IL 61704-3630 (309) 662-612050296 Surgicenter 10/01/04 Center for Reconstructive Surgery I 1 6309 West 95th Street Oak Lawn IL 60453 (708) 499-3355 N 02/01/0851444 Surgicenter 12/18/12 Central Illinois Endoscopy Center, LLC I 1 1001 Main St Peoria IL 61606-2037 (309) 495-1144 R 12/01/12

Appendix D HMO Illinois, Blue Advantage HMO and Blue Precision Contracting Providers

Change Codes:A: NewC: CancelD: Eff DateN: Prov. Name P: Prov. NumberR: ReinstateAC: Accrediation CancelAD: AddressCP: Cancel prov # changedPN: Name and Number TE: Telephone Number

1 Rev. 08-2014

Provider #

Provider Type



Change Code

Change Date


50492 Surgicenter 11/01/06 Central Illinois Gastrointesintal Institute I 1 2200 Jacobsen Drive Normal Il 61761-5516 (309) 451-1123 A 03/30/0750340 Surgicenter 02/01/05 11/01/13 Central Illinois Surgery Center, LLC I 1 304 W. Hay Street Decatur IL 62526-6328 (217) 876-8201 C 12/01/1351153 Surgicenter 02/01/09 Chicago Endoscopy Center I 1 3536 W. Fullerton Ave. Chicago IL 60647 (773) 772-1269 A 03/01/0950513 Surgicenter 11/01/06 Chicago Prostate Cancer Surgical Center I 1 815 Pasquinelli Drive Westmont IL 60559 (630) 654-2515 A 03/30/0750402 Surgicenter 10/01/05 Decatur Digestive Disease Center, LLC I 1 2 Memorial Drive Decatur IL 62526 (217) 233-0030 A 01/13/0653281 Surgicenter 01/01/14 Deerpath Orthopedic Surgical Center I 1 1051 W US Route 6 Morris IL 60450-4200 (815) 318-5666 A 03/01/1451756 Surgicenter 04/01/11 Dialysis Access Center LLC I 1 400 John Deere Road Moline IL 61265 (309) 797-0594 A 08/01/11

622 Surgicenter 01/01/98 09/01/11 Dimensions Med. Ctr. I 1 1455 Golf Road Des Plaines IL 60016 (847) 390-9300 C 09/01/1151857 Surgicenter 04/01/13 DMG Pain Management Surgery Center I 1 2940 Rolling Ridge Road Naperville IL 60564-4226 (630) 303-5304 A 04/01/1350429 Surgicenter 02/01/06 DMG Surgical Center, LLC I 1 2725 S. Technology Drive Lombard IL 60148 (630) 942-7998 A 05/08/06

590 Surgicenter 01/01/98 Dreyer Amb. Surgi. Ctr. I 1 1221 N. Highland Aurora IL 60605 (630) 859-870050703 Surgicenter 01/01/08 DuPage Eye Surgery Center, LLC I 1 2015 North Main St. Wheaton IL 60187 (630) 665-3690 A 07/01/0851566 Surgicenter 07/01/10 10/31/12 DuPage Orthopaedic Surgery Center, LLC I 1 27650 Ferry Road Warrenville IL 60555-3846 (630) 225-2700 CP 01/01/13

1545 Surgicenter 01/01/01 Eastland Med. Plaza Surgicenter, LLC I 1 1505 Eastland Drive Bloomington IL 61701-3502 (309) 663-1997 A 08/01/011538 Surgicenter 08/01/99 Elmhurst Outpatient Surgery I 1 1200 S. York Road Elmhurst IL 60126-5626 (630) 758-8457 A 09/01/99

50405 Surgicenter 03/08/06 03/19/14 Elmwood Park Sameday Surgery I 1 1614 North Harlem Ave. Elmwood Park IL 60707-4302 (708) 452-5000 R 08/15/0750371 Surgicenter 06/01/05 Eye Surgery Center of Hinsdale I 1 950 N. York Road Hinsdale IL 60521-8609 (630) 789-6700 A 10/11/05

1502 Surgicenter 01/01/98 Eyes of Illinois Surgery Center I 1 #12 Professional Park Drive Maryville IL 62062 (618) 451-1780 N 11/01/11520 Surgicenter 01/22/04 Family Planning Mgt. Inc. dba Albany Med. Surg. I 1 5086 North Elston Ave Chicago IL 60630 (773) 725-0200 N 09/01/09

50437 Surgicenter 04/01/11 Forest Medical Surgical Center I 1 9050 W 81st Street Justice IL 60458 (708) 594-3500 A 04/01/1150420 Surgicenter 01/01/06 Forest View Medical Center, Ltd I 1 2750 S. River Road Des Plaines IL 60018-4103 (847) 375-1000 A 03/01/07

1530 Surgicenter 12/01/98 Fox Valley Orthopedic Inst. I 1 2525 Kaneville Road Geneva IL 60134 (630) 584-1400 A 02/01/9950732 Surgicenter 07/01/08 Fullerton Surgery Center I 1 4849 W. Fullerton Ave Chicago IL 60639 (773) 237-2900 A 07/01/0850348 Surgicenter 04/01/05 Glen Endoscopy Center, LLC I 1 2551 Compass Road Glenview IL 60026 (800) 590-2713 A 06/07/0551832 Surgicenter 12/01/11 10/01/13 Gold Coast Surgicenter LLC I 1 845 N. Michigan Ave Chicago IL 60611 (312) 521-5500 C 10/01/13

545 Surgicenter 01/01/98 Golf Surgery Center I 1 8901 Golf Road DesPlaines IL 60016 (847) 299-227353311 Surgicenter 12/01/13 Good Samaritan Surgery Center I 1 2 Good Samaritan Way Mount Vernon IL 62864 (618) 436-6542 A 01/01/14

517 Surgicenter 01/01/98 Hawthorn Surgery Center. I 1 240 Center Drive Vernon Hills IL 60061 (847) 367-8100 AD 05/01/14


2 Rev. 08-2014

Provider #

Provider Type



Change Code

Change Date


1532 Surgicenter 04/01/99 Hinsdale Surgical Center,LLC I 1 908 N. Elm Street Hinsdale Il 60521 (630) 325-5035 N 05/01/9950669 Surgicenter 02/01/08 Hoffman Estates Surgery Center, LLC I 1 1555 Barrington Road Hoffman Estates IL 60169-1019 (847) 519-1600 A 02/01/0851265 Surgicenter 06/01/09 Illinois Center for Foot & Ankle Surgery, LLC I 1 4650 Southwest Highway Oak Lawn IL 60453 (708) 424-6353 A 06/01/0951256 Surgicenter 06/01/09 Illinois Sports Medicine & Orthopedic Surgery I 1 9000 Waukegan Road Morton Grove IL 60053 (847) 213-5444 A 06/01/09

535 Surgicenter 01/01/98 Ingalls Same Day Surgery I 1 6701 W. 159th Street Tinley Park IL 60477 (708) 429-022250730 Surgicenter 06/01/09 Ireland Grove Center for Surgery I 1 3801 Ireland Grove Road Bloomington IL 61704 (309) 664-0101 A 06/01/0950075 Surgicenter 04/01/02 Kendall Pointe Surgery Center I 1 100 W. Fifth Street Oswego IL 60543 (630) 449-0085 A 09/19/02

1539 Surgicenter 09/13/99 02/08/14 Kishwaukee Community Hospital I 1 2240 Gateway Drive Sycamore IL 60178 (815) 756-8571 C 03/01/1451087 Surgicenter 11/01/08 Lake Forest Endoscopy Center, LLC I 1 1475 E. Belvidere Rd . Suite 303 Grayslake IL 60030 (847) 548-8715 A 01/01/0951904 Surgicenter 04/01/12 Lindenhurst Surgery Center LLC I 1 1050 Red Oak Lane Lindenhurst IL 60046-4998 (800) 826-3784 A 06/01/12

1524 Surgicenter 01/01/98 Loyola Ambulatory Surgery Ctr. I 1 1 S. 224 Summit Avenue Oakbrook Terrace IL 60181 (708) 216-3291539 Surgicenter 01/01/98 Magna Surgical Center I 1 7456 South State Road Bedford Park IL 60638 (773) 445-9696 AD 08/01/11

51524 Surgicenter 04/01/10 Marion Eye Surgery Center LLC I 1 2900 Broadway Mount Vernon IL 62864-2341 (618) 969-8700 A 04/01/10598 Surgicenter 04/06/99 Marion Surgery Center I 1 806 N. Treas Marion IL 62959 (618) 993-2113 N 07/01/99

50422 Surgicenter 01/01/06 Michigan Avenue Center of Health, Ltd. I 1 2415 S. Michigan Ave Chicago IL 60616 (312) 328-1200 A 03/30/0750463 Surgicenter 07/01/13 Midland Surgical Center I 1 2120 Midland Surgical Center Sycamore IL 60178-3172 (815) 748-0393 A 10/01/1350623 Surgicenter 04/01/07 Midwest Ctr. for Day Surgery I 1 3811 Highland Avenue Downers Grove IL 60515-1555 (630) 852-9300 A 02/01/0850736 Surgicenter 05/01/08 Midwest Endocopy Center, LLC I 1 1243 Ricket Road Naperville IL 60540 (630) 525-6450 A 07/01/08

549 Surgicenter 05/01/07 Midwest Eye Care Center, S.C. I 1 1700 E. West Road Calumet City IL 60409 (708) 891-3330 R 09/01/1052020 Surgicenter 03/01/13 Monroe County Surgical Center LLC I 1 501 Hamacher St Waterloo IL 62298 (618) 939-1001 A 03/01/1351825 Surgicenter 12/01/11 Musculoskeletal Surgery Center I 1 303 N. Kumpf Blvd. Peoria IL 61605 (309) 676-5546 A 01/01/12

555 Surgicenter 01/01/98 Naperville Surg. Centre I 1 1263 Rickert Drive Naperville IL 60540 (630) 305-3300519 Surgicenter 03/08/06 North Shore Same Day Surgery I 1 3725 W. Touhy Avenue Lincolnwood IL 60712 (847) 324-7770 TE 01/01/13544 Surgicenter 01/01/98 12/31/13 Northwest Community Day Surgery I 1 675 West Kirchoff Road Arlington Hgts. IL 60008 (847) 618-1000 CP 02/01/14

53466 Surgicenter 01/01/14 Northwest Community Day Surgery I 1 675 West Kirchoff Road Arlington Hgts. IL 60008 (847) 618-1000 P 02/01/1450143 Surgicenter 01/01/98 Northwest Surgicare Center I 1 1100 West Centeral Arlington Hgts IL 60005 (847) 259-3080 N 03/07/0350079 Surgicenter 01/01/98 Novamed Eye Surgery Ctr. I 1 7427 West Lake Street River Forest IL 60305 (708) 771-3334 P 09/19/0250153 Surgicenter 01/01/98 NovaMed EyeCare Mgt., LLC I 1 3034 West Peterson Avenue Chicago IL 60659 (773) 973-3223 P 05/01/03


3 Rev. 08-2014

Provider #

Provider Type



Change Code

Change Date


50164 Surgicenter 04/01/98 Novamed Surgery Center/Merrillville I 1 8514 Broadway Street Merrillville IN 46410 (219) 756-5010 P 05/01/0352075 Surgicenter 06/01/13 Oak Brook Surgical Centre Inc. I 1 2425 W 22nd St. Oak Brook IL 60523-4642 (630) 990-2212 A 08/01/1350226 Surgicenter 08/01/03 06/01/13 Oak Lawn Endoscopy I 1 9921 Southwest Highway Oak Lawn IL 60453-3767 (708) 499-5687 CP 07/01/1352067 Surgicenter 06/01/13 Oak Lawn Endoscopy I 1 9921 Southwest Highway Oak Lawn IL 60453-3767 (708) 499-5678 P 07/01/1352106 Surgicenter 10/01/13 Oak Surgical Institute I 1 403 S Kennedy Drive Bradley IL 60915-2152 (815) 928-9999 A 12/01/1351440 Surgicenter 10/23/09 01/01/13 Oakbrook Surgical Center Inc. I 1 Oakbrook Surgical Center Inc. Oakbrook IL 60523-4641 (630) 990-2212 C 01/01/1351894 Surgicenter 05/01/12 Olympian Surgical Suites I 1 1002 Interstate Dr. Champaign IL 61822-1465 (217) 693-5700 A 05/01/1251598 Surgicenter 07/01/10 05/01/11 Olympian Surgical Suites I 1 1002 W. Interstate Drive Champaign IL 61822 (217) 693-5700 C 07/01/1150131 Surgicenter 11/01/02 Orland Park Surgical Center I 1 9550 W. 167th Street Orland Park IL 60467-5561 (708) 747-7960 A 03/07/03

1537 Surgicenter 10/20/00 Orthopaedic Surgery Center I 1 3136 Old Jacksonville Rd. Springfield IL 62704-6487 (217) 862-0500 A 11/01/0050032 Surgicenter 11/24/09 Palos SurgiCenter LLC I 1 7340 College Drive Palos Heights IL 60463 (708) 361-3223 R 12/01/09

1511 Surgicenter 01/01/98 Peoria Ambulatory Surgery Ctr. I 1 4909 N. Glen Park Place Peoria IL 61614 (309) 691-9069516 Surgicenter 01/01/98 Peoria Day Surgery Center I 1 7309 N. Knoxville Avenue Peoria IL 61614 (309) 692-9210 N 06/07/05

50935 Surgicenter 09/01/08 Physicians' Surgery Center, LLC I 1 2601 West Main St Carbondale IL 62901 (877) 377-1086 A 09/01/0851043 Surgicenter 11/01/08 Physicians Surgical Center Ltd. I 1 311 W. Lincoln St. Belleville IL 62220-1902 (618) 233-7077 P 01/01/0951092 Surgicenter 01/01/09 Plainfield Surgery Center, LLC I 1 24600 W 127th St. Plainfield IL 60585 (815) 436-0911 A 01/01/0950662 Surgicenter 11/01/07 06/30/11 Prairie Diagnostic Center LLC I 1 401 E. Carpenter Street Springfield IL 62702 (217) 527-3700 C 11/01/1151651 Surgicenter 12/01/10 Prairie Surgi Center Associates I 1 2020 W Iles Ave. Springfield IL 61704 (217) 698-3200 A 01/01/1150034 Surgicenter 11/05/01 Quad City Ambulatory Surg. Ctr. I 1 520 Valley View Drive Moline IL 61265 (309) 762-1952 P 01/23/0250139 Surgicenter 01/01/98 Quad City Endoscopy LLC I 1 2525 24th Street Rock Island IL 61201 (309) 788-5624 N 03/07/0351262 Surgicenter 05/01/09 Ravine Way Surgery Center LLC I 1 2350 Ravine Way Glenview IL 60025-7657 (847) 832-1555 A 06/01/0950416 Surgicenter 10/01/05 Renal Intervention Center, LLC I 1 430 Maxine Drive Morton IL 61550-2495 (309) 495-5420 A 08/01/10

1520 Surgicenter 01/01/99 04/24/13 Resurrection Health Care Surgery Center I 1 3115 N. Harlem Avenue Chicago IL 60634 (773) 889-2000 C 07/01/1351786 Surgicenter 09/01/11 Ritacca Laser Center Ltd. I 1 230 Center Drive Vernon Hills IL 60061-1584 (847) 367-8764 A 10/01/11

518 Surgicenter 03/08/06 River North Same Day Surgery Ctr. I 1 1 E. Erie Street Chicago IL 60611-3364 (312) 649-3939 R 10/16/071504 Surgicenter 01/01/98 Rockford Ambulatory Surgery Ctr. I 1 1016 Featherston Road Rockford IL 61107 (815) 226-3300

599 Surgicenter 01/01/98 Rockford Endoscopy Center I 1 401 Roxbury Road Rockford IL 61107 (815) 397-734051093 Surgicenter 01/01/09 Rockford Orthopedic Surgery Center, LLC I 1 346 Roxbury Rd Rockford IL 61107-5090 (815) 381-7400 A 01/01/09


4 Rev. 08-2014

Provider #

Provider Type



Change Code

Change Date


51130 Surgicenter 12/29/08 RSC Illinois i 1 545 Valley View Drive Moline IL 61265-6138 (309) 762-0280 N 04/01/10602 Surgicenter 02/04/99 Rush Surgi Center, Ltd. I 1 1725 West Harrison Chicago IL 60612 (312) 563-2269 A 04/01/99

50179 Surgicenter 02/01/03 Salt Creek Surgery Center I 1 530 North Cass Avenue Westmont IL 60559 (630) 968-1800 A 05/01/0350245 Surgicenter 03/31/03 07/24/13 SCHCI, LLC (Cardivovascular) I 1 1200 Maple Road Joliet IL 60432-1439 (815) 740-1100 C 08/01/1352094 Surgicenter 09/01/13 South Loop Endoscopy and Wellness Center LLC I 1 2336 40 S Wabash Ave. Chicago IL 60616 (312) 808-0468 A 09/01/1350495 Surgicenter 11/01/06 Surgery Center of Joliet I 1 301 Madison Joliet IL 60435 (815) 744-1119 A 03/30/0750510 Surgicenter 11/01/06 Surgi Center of Greater Milwaukee I 1 3223 S. 103rd Street Milwaukee WI 53227 (414) 328-5800 A 03/30/0751606 Surgicenter 09/01/10 Surgicore, Inc I 1 10547 S. Ewing Avenue Chicago IL 60617 (708) 895-9000 A 10/01/10

605 Surgicenter 01/01/98 The Center For Surgery I 1 475 E. Diehl Road Naperville IL 60563 (630) 505-773350438 Surgicenter 12/19/07 The Endo Center for Elgin Gastroenterology I 1 745 Fletcher Drive Elgin IL 60123 (847) 888-1300 A 02/01/08

582 Surgicenter 01/01/98 The Eye Surgery Center I 1 3990 N. Illinois Street Belleville IL 62231 (618) 277-113050315 Surgicenter 01/01/05 The Lake Bluff IL Endoscopy SC d/b/a No. Shore I 1 101 S. Waukegan Road Lake Bluff IL 60044 (847) 604-8700 P 03/08/0550193 Surgicenter 03/01/03 Tinley Woods Surgery Center I 1 18200 S. LaGrange Tinley Park IL 60477 (708) 570-2490 A 07/10/0350648 Surgicenter 09/01/07 Tri-Cities Surgery Center, LLC I 1 345 Delnore Drive Geneva IL 60134 (630) 262-8111 A 02/01/08

630 Surgicenter 01/01/98 United Shockwave Therapies-North I 1 1875 W. Dempster Street Park Ridge IL 60068 (847) 696-2210 N 12/18/02546 Surgicenter 01/01/98 Valley Ambulatory Surgery Ctr. I 1 2210 Dean Street St. Charles IL 60175 (630) 548-9800

50447 Surgicenter 07/01/06 Vista Surgery & Treatment Center I 1 1050 Red Oak Lane Lindenhurst IL 60046 (847) 356-4700 PN 12/28/06


5 Rev. 08-2014

Provider #

Provider Type



Change Code

Change Date


58414 Surgicenter 01/01/14 Western Diversey Surgical Center I 1 2744 N Western Ave. Chicago IL 60647-2017 (772) 772-7726 A 03/01/1450122 Surgicenter 05/01/02 Williams Eye Institute I 1 6836 Hohman Avenue Hammond IN 46324-1410 (219) 937-5063 N 01/13/03

A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association


6 Rev. 08-2014

Appendix D

Provider #Provider

TypeEffective

DateCancel Date Provider Name Class


Change Code

Change Date

1604073 DME 02/01/14 Absolute Medical X 0 328 Jefferson Street Chicago IL 60661 (312) 233-2207 A 01/01/142207274 DME 05/01/98 Achieve Mobility X 0 17W620 14th Street Terrace IL 60181 (630) 268-8670 N 04/01/089932649 DME 12/01/07 Advanced Respiratory X 0 2443 W. 16th Street Chicago IL 60608 (800) 426-4224 AD 02/01/131617625 DME 01/01/98 Advocate Home Care Products X 0 2311 W. 22nd Street Oak Brook IL 60523 (630) 572-59991632168 DME 04/18/02 Alverno Home Medical Equipment X 0 16149 S. Clinton Street Harvey IL 60426 (708) 331-4615 P 09/19/027270224 DME 10/01/99 American Home Patient X 0 1724 W. Chanute Rd Peoria IL 61615 (309) 691-7200 AD 07/01/118415051 DME 10/01/99 American Home Patient X 0 Road Springfield IL 62703 (217) 753-1525 A 03/01/004929926 DME 08/01/01 Animas Diabetes Care X 0 184 Shuman Blvd Naperville IL 60563 (877) 937-7867 AD 09/01/092220487 DME 01/01/96 Apria Health Care X 0 4055 Steele Dr. Machesney Pk IL 61115 (847) 252-2000 AD & TE 07/01/118423184 DME 01/01/06 Apria Health Care X 0 775 E. Linton Ave. Springfield IL 62703 (217) 789-0461 A 12/28/06723183 DME 01/01/06 Apria Health Care X 0 Drive Peoria IL 61615 (309) 691-1012 A 12/28/06

90001158 DME 01/01/06 Apria Health Care X 0 1581 E. 90th Place Merrillville IN 46410 (219) 736-1302 A 12/28/062220487 DME 01/01/13 Apria Healthcare X 0 2020 Glen Park Champaign IL 61821 (271) 876-9025 AL 08/01/132220487 DME 01/01/13 Apria Healthcare X 0 1912 W Rendelman Marion IL 62959 (618) 997-6469 AL 08/01/132220487 DME 01/01/13 Apria Healthcare X 0 19 ABC PKWY Collinsville IL 62234 (618) 343-3700 AL 08/01/132220487 DME 01/01/13 Apria Healthcare X 0 4711 W 135th ST Crestwood IL 60445 (708) 597-7079 AL 08/01/132220487 DME 01/01/13 Apria Healthcare X 0 10910 N 2nd St. Machesney Park IL 61115 (815) 633-7778 AL 08/01/132220487 DME 01/01/13 Apria Healthcare X 0 1016 NorthPoint Blvd Waukegan IL 60085 (847) 473-0739 AL 08/01/132220487 DME 01/01/13 Apria Healthcare X 0 1103 M L King Dr Bloomington IL 61701 (309) 828-9047 AL 08/01/132220487 DME 01/01/13 Apria Healthcare X 0 500 W Jaycee Ave Effingham IL 62401 (217) 347-5212 AL 08/01/13

HMO Illinois/Blue Advantage HMO Contracting Providers

Change Codes:A: NewC: CancelN: Prov. Name P: Prov. NumberR: ReinstateAC: Accrediation CancelAD: AddressCP: Cancel prov # changedPN: Name and Number TE: Telephone NumberTI: Transfer into a classTO: Transfer out of a class 1 Rev.08-2014

Appendix D

Provider #Provider

TypeEffective



Change Code

Change Date


2220487 DME 01/01/13 Apria Healthcare X 0 1300 W Ogden Ave Naperville IL 60563 (630) 369-6500 AL 08/01/132220487 DME 01/01/13 Apria Healthcare X 0 3453 Rupp Pkwy Decatur IL 62526 (217) 876-9025 AL 08/01/132220487 DME 01/01/13 Apria Healthcare X 0 Industrial Streator IL 61364 (815) 673-3751 AL 08/01/139932364 DME 11/01/09 Baar Home Medical Equipment X 0 24760 W Eames Street Channahon IL 60410 (815) 467-0072 A 11/01/092232523 DME 01/01/06 Bari Care, Inc. X 0 8404 S. Wilmette Ave Darien IL 60561 (630) 964-6528 A 01/13/069971517 DME 08/01/06 Basinger's Pharmacy X 0 2130 W. Jefferson Street Joliet IL 60435 (815) 725-1102 A 12/28/06

80001621 DME 07/01/12Bioventus, LLC (new name for Smith Nephew) X 0 1450 E Brooks Rd Memphis TN 38116 (800) 396-4325 A 07/01/12

1629993 DME 04/01/02 Byram Healthcare X 0 3010 Woodcreek Drive Downers Grove IL 60515 (800) 681-1395 A 07/09/0234140288 DME 11/01/05 Care Medical Supplies Inc. X 0 4201 IIberry Road Mt. Vernon IL 62864 (618) 244-4949 P 08/01/1111642527 DME 11/01/05 Care Medical Supplies Inc. X 0 6500 W Main Street Belleville IL 62223 (618) 398-3762 P & AD 08/01/111670187 DME 11/01/05 Care Medical Supplies Inc. X 0 333 W Hintz Road Wheeling IL 60090 (847) 947-4160 P 05/01/105632525 DME 01/01/13 Centegra Home Medical Equipment X 0 213 N Front Street McHenry IL 60050 (815) 759-4444 A 12/01/122232502 DME 09/15/09 Classic Medical Inc. X 0 2000 Bloomingdale Road Heights IL 60139 (866) 261-2179 A 10/01/092233029 DME 12/01/06 CNS Home Infusion & Pharmacy X 0 690 E. North Ave. Carol Stream IL 60188 (630) 933-7777 TE 07/21/117232275 DME 01/01/13 Complete Home Respiratory Care X 0 1605 W Chanute Rd Peoria IL 61615 (309) 689-5038 A 12/01/122234595 DME 02/01/13 Compliant Sleep Solutions X 0 7501 Lemont Rd Woodridge IL 60517 (630) 324-5370 A 02/01/134521209 DME 07/01/98 Delnor Comm. Hosp. Home Hlth X 0 300 Randall Road Geneva IL 4200 (630) 513-0370 TE 07/01/112233260 DME 01/01/13 Delta Sleep, Inc X 0 3510 Hobson Road Woodridge IL 60517 (630) 960-2727 A 12/01/122270097 DME 01/01/95 Denson Shops Inc. X 0 509 S. Carlton Street Wheaton IL 60187 (630) 665-1488


Appendix D

Provider #Provider

TypeEffective



Change Code

Change Date


80001617 DME 03/01/13 Dexcom, Inc X 0 6340 Sequence Dr San Diego CA 92121 (888) 738-3646 A 04/01/131627524 DME 08/01/01 DJ O LLC X 0 1308 Lakeview Drive Palatine IL 60067 (877) 406-9676 TE 06/01/091617040 DME 01/01/06 Doubek Medical Supply X 0 11350 S. Cicero Ave. Alsip IL 60803 (773) 581-1122 A 01/13/06

2234829 DME 11/01/11Dupage Medical Group dba Premier Medical Equipment X 0 428 Pennsylvania Ave Glen Ellyn IL 60137 (630) 545-7770 A 12/01/11

5022926 DME 06/01/06 Dwight Drugs, Inc. X 0 109 E. Main Street Streator IL 61364 (815) 672-2968 A 12/28/0680001664 DME 12/01/12 Dynasplint Systems, Inc X 0 770 Ritchie Hwy Severna Park MD 21146 (800) 638-6771 A 12/01/124932133 DME 12/01/02 EBI LLC X 0

gCircle Elburn IL 60119 (800) 526-2579 N & AD 09/01/10

5632003 DME 05/01/10 Edgepark Medical Supplies X 0 1360 Madeline Lane Elgin IL 60124 (800) 307-5930 A 06/01/10

2232463 DME 01/01/06Elmhurst Memorial Home Health DME dba Action Medical Equipment X 0 855 N. Church Center Elmhurst IL 60126 (630) 758-7000 N 09/01/09

82015000 DME 01/01/95 EMPI, Inc X 0 599 Cardigan Road St. Paul MN 55126 (800) 328-25364921058 DME 09/15/09 Fair Haven Medical Supply X 0 608 E Hawley Street Mundelein IL 60060 (847) 566-5801 A 10/01/09

90001059 DME 03/01/02 Fairmeadows Home Health Center, Inc. X 0 400 Kennedy Ave. Schererville IN 46375 (219) 865-5960 A 07/09/027230214 DME 04/01/07 Family Medical Equipment X 0 1837 N. Knoxville Ave. Peoria IL 61603 (309) 682-1900 A 02/01/081670010 DME 01/01/95 Fitzsimmons Surgical Supply X 0 6428 N. Milwaukee Chicago IL 60631 (773) 881-87001670010 DME 01/01/95 Fitzsimmons Surgical Supply X 0 2600 Beverly Dr. Aurora IL 60502 (630) 851-88511670010 DME 03/01/14 Fitzsimmons Surgical Supply X 0 6177 Broadway Merrillville IN 46410 (219) 887-7719 AL 05/01/141670010 DME 03/01/14 Fitzsimmons Surgical Supply X 0 8000 W 186th St Tinley Park IL 60487 (708) 532-1199 AL 05/01/141670010 DME 01/01/95 03/01/14 Fitzsimmons Surgical Supply X 0 1906 N. Halsted Chicago IL 60614 (773) 665-0080 C 05/01/14


Appendix D

Provider #Provider

TypeEffective



Change Code

Change Date


1670010 DME 01/01/95 03/01/14 Fitzsimmons Surgical Supply X 0 6442 W. Cermak Berwyn IL 60402 (708) 795-6300 C 05/01/141670010 DME 01/01/95 03/01/14 Fitzsimmons Surgical Supply X 0 11925 S. Harlem Palos Heights IL 60463 (708) 361-3500 C 05/01/141670010 DME 01/01/95 03/01/14 Fitzsimmons Surgical Supply X 0 2747 W. 95th Street Evergreen Park IL 60805 (773) 881-8700 C 05/01/141670010 DME 01/01/95 03/01/14 Fitzsimmons Surgical Supply X 0 17660 S. Kedzie Hazel Crest IL 60429 (708) 957-9500 C 05/01/148215183 DME 06/01/06 Fox Medical Equipment Services X 0 1832 Vandalia Street Collinsville IL 62234 (618) 345-0649 A 12/28/06

90001306 DME 03/01/07 Genesis Medical X 0 1164 E. 86th Place Merrillville IN 46410 (317) 347-2000 A 10/16/071671535 DME 07/01/08 Gottlieb Prof Building Pharmacy X 0 675 W. North Avenue Melrose Park IL 60160 (708) 450-4941 A 08/01/081670200 DME 03/01/01 07/01/11 Health Link Services Inc. X 0 16135 New Ave. Lemont IL 60439 (708) 594-2244 C 07/01/112223252 DME 02/01/01 Health Technology Resources, LLC X 0 600 Academy Drive Northbrook IL 60062 (847) 291-2637 A 03/01/011671073 DME 01/01/95 High Street Pharmacy X 0 2320 High Street Blue Island IL 60406 (708) 388-00331618960 DME 01/01/98 Hill-Rom Company X 0 8500 185th Street Tinley Park IL 60487 (800) 638-2546 AD, TE 04/01/142233148 DME 10/15/09 Home Medical Express X 0 650 W Grand Ave. Elmhurst IL 60126 (630) 530-9777 A 10/01/091632492 DME 09/01/02 Hoveround Corporation X 0 241 S. Frontage Road Burr Ridge IL 60527 (800) 701-5781 A 12/18/029222357 DME 01/01/05 Illiana Medical Equipment X 0 912 N. Vermilion Street Danville IL 61832 (217) 442-0654 PN 01/10/052233765 DME 10/15/09 Independence Plus X 0 720 Enterprise Drive Oak Brook IL 60523 (630) 463-4400 A 11/01/092233787 DME 01/01/12 Integra HealthCare Equipment X 0 747 N Church Rd Elmhurst IL 60126 (630) 834-3700 A 02/01/12

10170824 DME 01/01/95 Integrated HomeCare Services X 0 5027 Harrison Ave. Rockford IL 61108 (815) 227-0202 TE 06/01/094532183 DME 10/01/04 Integrated Homecare Services X 0 2000 Bloomingdale Road Heights IL 60139 (877) 426-0202 TE 07/01/118232389 DME 08/17/09 IV Care LLC X 0 65 S. 65th Street Belleville IL 62223 (618) 398-2720 P 08/01/092571346 DME 03/01/05 Joint Active Systems X 0 2600 S. Raney Street Effingham IL 62401 (217) 342-3412 A 06/07/05


Appendix D

Provider #Provider

TypeEffective



Change Code

Change Date


7221211 DME 10/01/04 KCI USA Inc. X 0 4105 N. Becker Drive Bartonville IL 61607 (309) 633-2281 AD 02/01/102221210 DME 07/01/05 KCI USA Inc. X 0 1193 N Ellsworth Villa Park IL 60181 (800) 275-4524 AD 08/01/149921295 DME 01/01/03 Kramer Enterprises, Ltd X 0 3077 W. Jefferson Street Joliet IL 5264 (815) 773-9028 TE 07/01/111621096 DME 09/01/02 Kreg Therapeutic Inc. X 0 2240 W. Walnut Chicago IL 60612 (866) 760-5734 TE 07/01/111932093 DME 07/01/11 Lehan Drugs, Inc X 0 1407 So 4th St DeKalb IL 60115 (815) 758-0911 A 08/01/119222398 DME 11/01/01 01/01/13 Lincare, dba Patients First Pulmonary X 0 270 W. North Ave. Villa Park IL 60181 C 08/01/139222398 DME 11/01/01 Lincare, dba Patients First Pulmonary X 0 270 W. North Ave. Villa Park IL 60181 A 04/29/029222398 DME 11/01/01 Lincare, dba Pediatric Specialists X 0 2755 B Cirtoss Street Downers Grove IL 60515 (630) 960-9933 A 04/29/029222398 DME 11/01/01 01/01/13 Lincare, dba Pediatric Specialists X 0 2755 B Cirtoss Street Downers Grove IL 60515 (630) 960-9933 C 08/01/132523825 DME 01/01/13 Lincare, Inc. X 0 1701 Howard St. Elk Groove IL 60007 (847) 806-8080 AL 08/01/132523825 DME 01/01/13 Lincare, Inc. X 0 271 N Industrial Dr. Bradley IL 60915 (815) 932-1392 AL 08/01/132523825 DME 01/01/13 Lincare, Inc. X 0 2218 E Logan St. Decature IL 62526 (217) 422-4140 AL 08/01/132523825 DME 01/01/13 Lincare, Inc. X 0 Rd. Muphysboro IL 62966 (618) 687-9229 AL 08/01/132523825 DME 01/01/13 Lincare, Inc. X 0 7101 S Adams St. WillowBrook IL 60527 (630) 850-7296 AL 08/01/132523825 DME 01/01/13 Lincare, Inc. X 0 1613 Commerce PKWY Bloomington IL 61704 (309) 661-7349 AL 08/01/132523825 DME 01/01/13 Lincare, Inc. X 0 4808 N Sheridan Rd. Peoria IL 61614 (309) 679-2093 AL 08/01/132523825 DME 01/01/13 Lincare, Inc. X 0 602 S Staley Rd Champaign IL 61822 (217) 398-8191 AL 08/01/132523825 DME 01/01/13 Lincare, Inc. X 0 825 E Golf Rd Arlington Hts IL 60005 (847) 952-1579 AL 08/01/132523825 DME 01/01/13 Lincare, Inc. X 0 53 E Simmons St. GalesBurg IL 61401 (309) 343-2776 AL 08/01/132523825 DME 01/01/13 Lincare, Inc. X 0 2349 W. Grand Chicago IL 606012 (312) 733-7157 AL 08/01/13


Appendix D

Provider #Provider

TypeEffective



Change Code

Change Date


2523825 DME 01/01/13 Lincare, Inc. X 0 935 Maine St. Qunicy IL 62301 (217) 222-1983 AL 08/01/132523825 DME 01/01/13 Lincare, Inc. X 0 1150 N BradFordton Rd Springfield IL 62711 (217) 793-6029 AL 08/01/132523825 DME 01/01/13 Lincare, Inc. X 0 1000 Brown St. Wauconda IL 60084 (847) 526-1357 AL 08/01/139222398 DME 11/01/01 Lincare, Inc. X 0 839 E. Voorhess Danville IL 61832 (217) 431-1524 TE 08/01/112523825 DME 04/01/05 Lincare, Inc. X 0 700 N. Henerietta Effingham IL 62401 (217) 347-7002 TE 07/01/112523825 DME 01/01/13 Lincare, Inc. X 0 8910 W. 192nd St. Mokena IL 60448 (708) 478-3941 AL 08/01/132523825 DME 01/01/13 Lincare, Inc. X 0 1128 Royal Heights Rd Belleville IL 62226 (618) 235-4458 AL 08/01/131670691 DME 01/01/95 Little Co. of Mary Home Health Equip. X 0 5610 W. 95th Street Oak Lawn IL 2343 (708) 499-00711633478 DME 10/01/06 Loyola University DME X 0

g54 Maywood IL 60153 (708) 216-0435 TE 07/01/11

1617237 DME 11/01/05 Mark Drug X 0 548A W. Dundee Road Wheeling IL 60090 (847) 537-8500 TE 07/01/11

1670876 DME 01/01/96 12/01/11Mark Drug Home Health dba Pinnacle Rehab Solutions X 0

1457 W. Schaumburg Rd Schaumburg IL

60194-4051 (847) 895-0011 C 01/01/12

4915218 DME 02/01/14 Medline Industries X 0 1 Medline Place Mundelein IL 60060 (847) 837-2753 A 02/01/141621940 DME 09/21/09 Medsource, LLC X 0 700 N Sacramento Blvd Chicago Il 60612 (888) 510-5100 P, AD 10/01/091621940 DME 03/01/05 Medsource, LLC X 0 3002 Gill Street Bloomington IL 61704 (309) 664-7930 A 06/07/054932943 DME 06/01/13 Medtech Medical X 0 1602 Barclay Blvd Buffalo Grove IL 60089 (847) 520-3000 A 06/01/138421746 DME 04/01/98 Memorial Homecare X 0 644 N. Second Street Springfield IL 62702 (217) 788-46635632486 DME 10/01/10 Mercy Assisted Care X 0 1819 N Division St Harvard IL 60033 (815) 943-2071 A 11/01/102232948 DME 06/01/06 Merit Sleep Technologies X 0 1300 S. Main Street Lombard IL 60148 (630) 652-7900 A 02/01/081670603 DME 11/01/05 Metro Rehab Serv. Inc. X 0 11551 S. Ridgeland Ave. Alsip IL 60803 (708) 361-7060


Appendix D

Provider #Provider

TypeEffective



Change Code

Change Date


1634992 DME 10/15/09Midwest Medical Equipment Solutions dba Neb Medical Services X 0 7646 W 159th Street Orland Park IL 60462 (708) 633-1560 N 06/01/11

2225704 DME 02/02/02 Minimed Distribution Corp. X 0 3725 25th Ave Schiller Park IL 60176 (800) 341-3849 AD 02/01/1321622172 DME 09/01/07 Mobility Systems & Solutions X 0 9755 S. 78th Ave. Hickory Hills IL 60457 (708) 599-3500 TE 09/01/0880001659 DME 11/01/12 National Biological Corporation X 0 23700 Merchantile Rd Beechwood OH 44122 (216) 831-0600 A 12/01/129920264 DME 05/20/13 National Seating & Mobility X 0 11551 S Ridgeland Ave Alsip IL 60803 (708) 361-7060 AL 06/01/139920264 DME 04/01/09 National Seating & Mobility X 0 South Lombard IL 60148 (630) 495-3751 AD & TE 06/01/134570084 DME 01/01/95 Neumann's Home Medical Equip. X 0 821 W. Illinois Ave Aurora IL 60506 (630) 897-6444 AD 07/01/111600454 DME 07/09/09 NorthShore University Health System X 0 4901 Searle Parkway Skokie IL 60077 (847) 475-2001 TE 07/01/11

1623638 DME 02/01/01 05/01/14Ophthalmic Support Systems - (Vitectomy equip) X 0 1942 W. Wolfram Street Chicago IL 60657 (773) 404-2148 C 06/01/14

8123498 DME 08/01/00 Optioncare of the Quad Cities X 0 5111 22nd Avenue Moline IL 61265 (309) 762-7979 A 09/01/001618646 DME 01/01/95 Orsini Home Medical Equipment X 0 1111 Nicholas Blvd Villiage IL 60007 (847) 860-0240 AD & TE 07/01/111621072 DME 08/01/00 Orthofix Inc. X 0 875 N Michigan Ave Chicago IL 60611 (800) 527-0404 AD 02/01/124632003 DME 01/01/05 OrthoRx, Inc. X 0 1306 Gemini Circle Ottawa IL 61350 (815) 936-6040 A 03/08/054632003 DME 01/01/05 07/01/11 OrthoRx, Inc. X 0 1051 W. US Route 6 Morris IL 60450 (815) 941-1879 CL 08/01/114632003 DME 01/01/05 OrthoRx, Inc. X 0 400 S. Kennedy Drive Bradley IL 60915 (815) 936-60404632003 DME 01/01/05 OrthoRx, Inc. X 0 1405 W. Park Street Urbana IL 61801 (217) 384-6913 CL 08/01/115732277 DME 07/01/13 OSF Home Medical Equipment X 0 1505 Eastland Dr Bloomington IL 61701 (309) 665-4765 A 08/01/13

10120714 DME 07/01/13 OSF Home Medical Equipment X 0 5668 E State St Rockford IL 61108 (815) 227-2079 A 08/01/13


Appendix D

Provider #Provider

TypeEffective



Change Code

Change Date


3732061 DME 07/01/13 OSF Home Medical Equipment X 0 125 N Tremont St Kewanee IL 61443 (309) 854-6980 A 08/01/135332047 DME 07/01/13 OSF Home Medical Equipment X 0 608 N Ladd St Pontiac IL 61764 (815) 844-4906 A 08/01/132234394 DME 01/01/10 Otto Bock Orthopedic Services X 0 764 Burr Oak Dr Westmont IL 60559 (800) 736-8276 A 04/01/10432001 DME 05/01/12 Pacific Pulmonary Services X 0 3384 N Publishers Dr Rockford IL 61109 (818) 874-1314 A 05/01/12432001 DME 05/01/12 Pacific Pulmonary Services X 0 2201 W Townline Rd Peoria IL 61615 (309) 693-0375 A 05/01/12432001 DME 05/01/12 Pacific Pulmonary Services X 0 1551 E. 91st Street Dr Merrillville IL 46410 (219) 736-5828 A 05/01/12432001 DME 05/01/12 Pacific Pulmonary Services X 0 4511 N. Kedzie Ave Chicago IL 60625 (773) 477-8802 A 05/01/12432001 DME 05/01/12 Pacific Pulmonary Services X 0 1521 Wright Blvd Schaumburg IL 60193 (847) 895-4834 A 05/01/12432001 DME 05/01/12 Pacific Pulmonary Services X 0 9935 S 76th Ave Bridgeview IL 60455 (708) 599-7339 A 05/01/12

6921724 DME 07/01/98 Passavant Home Care X 0 306 N. Westgate Ave. Jacksonville IL 62650 (217) 245-8365 A 09/01/982270918 DME 01/01/95 Premier Medical Products, Inc. X 0 708 W. Fifth Ave. Naperville IL 60563 (630) 420-0308

80001666 DME 10/29/12 Prentke Romich Company X 0 1022 Heyl Rd Wooster OH 44691 (330) 262-1984 A 12/01/127220977 DME 08/01/09 Proctor Medical Equipment X 0 5409 N Knoxville Avenue Peoria IL 61614 (309) 689-6020 AD 07/01/111671041 DME 01/01/95 04/01/12 Quality Home Health Care Inc. X 0 525 W. Golf Road Arlington IL 3904 (847) 640-3944 C 04/01/12

2232027 DME 03/08/10 Rehab Tech Supply Corp dba Life Tech X 0 650 W. Grand Ave. Elmhurst IL 60126 (888) 800-9445 N 07/01/111621146 DME 01/01/00 07/01/11 Rehabtech Inc. X 0 16W240 83rd Street Burr Ridge IL 60527 (630) 920-0044 CL 08/01/111621146 DME 01/01/00 09/28/11 Rehabtech Inc. X 0 302 Edmund St. Peoria IL 61615 (309) 691-5805 C 11/01/111621146 DME 01/01/00 09/28/11 Rehabtech Inc. X 0 335 Eisenhower Lane Lombard IL 60148 (630) 420-8585 C 11/01/111621146 DME 01/01/00 09/28/11 Rehabtech Inc. X 0

p gAvenue Champaign IL 61820 (217) 366-9287 C 11/01/11

4922046 DME 10/01/98 Reliable Medical Supplies X 0 200 Howard Street Des Plaines IL 60018 (847) 566-0800 AD 09/01/09Change Codes:A: NewC: CancelN: Prov. Name P: Prov. NumberR: ReinstateAC: Accrediation CancelAD: AddressCP: Cancel prov # changedPN: Name and Number TE: Telephone NumberTI: Transfer into a classTO: Transfer out of a class 8 Rev.08-2014

Appendix D

Provider #Provider

TypeEffective



Change Code

Change Date


9970392 DME 01/01/95 Remco Medical X 0 2313 Oak Leaf Street Joliet IL 60435 (815) 744-4600 AD 10/01/091627258 DME 06/01/08 Resurrection Services X 0 5747 W. Dempster Morton Grove IL 60053 (847) 568-8500 A 07/01/084670322 DME 01/01/95 Riverside Health Equipment X 0 1270 N. Kennedy Drive Kankakee IL 60901 (815) 935-75081671321 DME 02/01/01 Service Medical Equipment X 0 2848 Hitchcock Ave. Downers Grove IL 60515 (630) 848-1900 TE 07/01/114570935 DME 01/01/95 Sherman Home Care Partners X 0 1019 E. Chicago Street Elgin IL 60120 (847) 429-62001670178 DME 08/01/00 Simpol Respiratory Equip., Inc. X 0

gRoad Morton Grove IL 60053 (847) 967-6767 A 10/01/00

1619273 DME 01/01/95 Siona Health Care Products X 0 5011 N. Lincoln Ave. Chicago IL 60625 (773) 907-068090000958 DME 05/01/01 Slattery Health Appliance Center X 0 2030 45th Avenue Highland IN 2812 (219) 836-1808 AD&TE 01/01/091635719 DME 03/01/14 Sleep Rx LLC X 0 7536 N St Louis Skokie IL 60076 (847) 676-4138 A 03/01/141630056 DME 07/01/01 Sleepmed Therapy Services, Inc. X 0 2357 W. Hassel Road Hoffman Estates IL 60169 (847) 490-9309 AD 07/01/114532198 DME 10/01/04 07/01/12 Smith Nephew Inc X 0 673 Academy Drive Northbrook IL 60062 (800) 821-5700 C 07/01/122220434 DME 01/01/13 Snyder-Mark Drugs Roselle X 0 A 10/01/132870548 DME 01/01/98 Southern Ill Surgical Appliance X 0 19 W. Frankfort Plaza West Frankfort IL 62896 (618) 932-31571633047 DME 01/01/06 Sterling Medical Services X 0 140 Exchange Blvd. Glendale Hgt IL 60139 (856) 273-9900 A 01/13/06

10132143 DME 01/01/05 06/01/12 Swedish American DME X 0 2550 Charles Street Rockford IL 61108 (815) 391-7550 C 06/01/124926898 DME 03/01/10 Symed, Inc X 0 2502 N Clark Street Chicago IL 60614 (773) 477-8993 A 03/01/10

80001620 DME 07/01/12 Tactile Systems Technology X 0 1331 Tyler St NE Minneapolis MN 55480 (866) 435-3948 A 07/01/122219496 DME 05/01/06 Thera Tech Equipment X 0 108 W. Washington St. Bloomingdale IL 60108 (630) 351-3333 A 12/28/064532691 DME 11/15/08 THH Acquisition LLC X 0 780 S. McLean Blvd. Elgin IL 60123 (847) 931-9300 A 04/01/09


Appendix D

Provider #Provider

TypeEffective



Change Code

Change Date


2234830 DME 09/28/11United Seating & Mobility dba Numotion X 0 335 Eisenhower Ln Lombard IL 60148 (630) 424-0330 N 09/01/13

2234830 DME 09/28/11United Seating & Mobility dba Numotion X 0 302 Edmund Street East Peoria IL 61611 (309) 698-3257 N 09/01/13

1620818 DME 03/01/97 Unlimited Advacare Systems X 0 2939 N. Pulaski Road Chicago IL 5421 (773) 725-8858 N 07/01/111616053 DME 09/01/10 Van Driels Medical Support Wear X 0 Highway Mt Prospect IL 60056 (847) 253-6494 A 09/01/109932878 DME 01/01/09 Walgreen Medical Supply X 0 8402 183rd Street Tinley Park IL 60487 (888) 410-5779 A 05/01/092221749 DME 08/21/98 Walgreens Home Care X 0 655 W. Grand Ave. Elmhurst IL 60126 (630) 530-0579 N 02/01/08

1617011 DME 01/01/95Walgreens Sleep and Respiratory Services X 0 1226 N Michael Dr Wood Dale IL 60191 (630) 741-4700 AD, TE 09/01/12

1617011 DME 09/01/11Walgreens Sleep and Respiratory Services X 0 2425 Bethany Rd Sycamore IL 60178 (800) 738-8233 N 01/01/12

1617011 DME 09/01/11Walgreens Sleep and Respiratory Services X 0 1250 Larry Powell Rd Bourbonnais IL 60914 (800) 979-1250 N 01/01/12

80001622 DME 07/01/12 Zoll LifeCor Corp X 0 121 Gamma Drive Pittsburgh PA 15238 (800) 543-3267 A 07/01/12



Appendix D

Provider #

Provider Type

Effective Date

Cancel Date Provider Name Class


Change Code

Change Date

9932649 DME 12/01/07 Advanced Respiratory X 0 2443 W. 16th Street Chicago IL 60608 (800) 426-42241617625 DME 01/01/98 Advocate Home Care Products X 0 2311 W. 22nd Street Oak Brook IL 60523 (630) 572-59991632168 DME 04/18/02 Alverno Home Medical Equipment X 0 16149 S. Clinton Street Harvey IL 60426 (708) 331-46152220487 DME 01/01/13 Apria Healthcare X 0 1300 W Ogden Ave Naperville IL 60563 (630) 369-65002220487 DME 01/01/13 Apria Healthcare X 0 4711 W 135th ST Crestwood IL 60445 (708) 597-70792220487 DME 01/01/13 Apria Healthcare X 0 1016 NorthPoint Blvd Waukegan IL 60085 (847) 473-07392220487 DME 01/01/13 Apria Healthcare X 0 10910 N 2nd St. Machesney Park Machesney Park IL 61115 (815) 633-7778

90001158 DME 01/01/06 Apria Healthcare X 0 1581 E. 90th Place Merrillville IN 46410 (219) 736-13022220487 DME 01/01/11 Apria Healthcare dba Garrity Home Care X 0 1287 W Galena, Freeport IL 61032 (815) 233-21229971517 DME 08/01/06 Basinger's Pharmacy X 0 2130 W. Jefferson Street Joliet IL 60435 (815) 725-11021629993 DME 04/01/02 Byram Healthcare X 0 3010 Woodcreek Drive Downers Grove IL 60515 (800) 681-13952233029 DME 12/01/06 CNS Home Infusion & Pharmacy X 0 690 E. North Ave. Carol Stream IL 60188 (630) 933-77771627524 DME 08/01/01 DJ O LLC X 0 1308 Lakeview Drive Palatine IL 60067 (877) 406-9676

2234829 DME 11/01/11Dupage Medical Group dba Premier Medical Equipment X 0 428 Pennsylvania Ave Naperville IL

5632003 DME 05/01/10 Edgepark Medical Supplies X 0 1360 Madeline Lane Elgin IL 60124 (800) 307-5930

2232463 DME 01/01/06Elmhurst Memorial Home Health DME dba Action Medical Equipment X 0 X 0 855 N. Church Center Elmhurst IL 60126 (630) 758-7000

82015000 DME 01/01/95 EMPI, Inc X 0 599 Cardigan Road St. Paul MN 55126 (800) 328-25361671535 DME 07/01/08 Gottlieb Prof Building Pharmacy X 0 675 W. North Avenue Melrose Park IL 60160 (708) 450-4941

10170824 DME 01/01/95 Integrated HomeCare Services X 0 5027 Harrison Ave. Rockford IL 61108 (815) 227-0202

Blue Precision HMO Contracting Providers


Appendix D

Provider #

Provider Type

Effective Date



Change Code

Change Date


7221211 DME 10/01/04 KCI USA Inc. X 0 4105 N. Becker Drive Bartonville IL 61607 (309) 633-22812221210 DME 07/01/05 KCI USA Inc. X 0 1193 N Ellsworth Villa Park IL 60181 (800) 275-4524 AD 08/01/149222398 DME 11/01/01 Lincare, dba Pediatric Specialists X 0 2755 B Cirtoss Street Downers Grove IL 60515 (630) 960-9933 2523825 DME 01/01/13 Lincare, Inc. X 0 825 E Golf Rd Arlington Hts IL 60005 (847) 952-1579 2523825 DME 01/01/13 Lincare, Inc. X 0 271 N Industrial Dr. Bradley IL 60915 (815) 932-1392 2523825 DME 01/01/13 Lincare, Inc. X 0 1000 Brown St. Wauconda IL 60084 (847) 526-1357 2523825 DME 01/01/13 Lincare, Inc. X 0 7101 S Adams St. WillowBrook IL 60527 (630) 850-7296 2523825 DME 01/01/13 Lincare, Inc. X 0 2349 W. Grand Chicago IL 60612 (312) 733-7157 2523825 DME 01/01/13 Lincare, Inc. X 0 8910 W. 192nd St. Mokena IL 60448 (708) 478-3941 2523825 DME 01/01/13 Lincare, Inc. X 0 1701 Howard St. Elk Groove IL 60007 (847) 806-80801670691 DME 01/01/95 Little Co. of Mary Home Health Equip. X 0 5610 W. 95th Street Oak Lawn IL 60453 (708) 499-00711633478 DME 10/01/06 Loyola University DME X 0 2160 S. First Ave. Bldg 54 Maywood IL 60153 (708) 216-0435 5632486 DME 10/01/10 Mercy Assisted Care X 0 1819 N Division St Harvard IL 60033 (815) 943-20712225704 DME 02/02/02 Minimed Distribution Corp. X 0 3725 25th Ave Schiller Park IL 60176 (800) 341-3849

80001659 DME 11/01/12 National Biological Corporation X 0 23700 Merchantile Rd Beechwood OH 44122 (216) 831-06001600454 DME 07/09/09 NorthShore University Health System X 0 4901 Searle Parkway Skokie IL 60077 (847) 475-20011621072 DME 08/01/00 Orthofix Inc. X 0 875 N Michigan Ave Chicago IL 60611 (800) 527-04043732061 DME 07/01/13 OSF Home Medical Equipment X 0 125 N Tremont St Kewanee IL 61443 (309) 854-6980

10120714 DME 07/01/13 OSF Home Medical Equipment X 0 5668 E State St Rockford IL 61108 (815) 227-20795332047 DME 07/01/13 OSF Home Medical Equipment X 0 608 N Ladd St Pontiac IL 61764 (815) 844-4906


Appendix D

Provider #

Provider Type

Effective Date



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2270918 DME 01/01/95 Premier Medical Products, Inc. X 0 708 W. Fifth Ave. Naperville IL 60563 (630) 420-030880001666 DME 10/29/12 Prentke Romich Company X 0 1022 Heyl Rd Wooster OH 44691 (330) 262-19841627258 DME 06/01/08 Resurrection Services X 0 5747 W. Dempster Morton Grove IL 60053 (847) 568-85004670322 DME 01/01/95 Riverside Health Equipment X 0 1270 N. Kennedy Drive Kankakee IL 60901 (815) 935-7508

80001620 DME 07/01/12 Tactile Systems Technology X 0 1331 Tyler St NE Minneapolis MN 55480 (866) 435-39482234830 DME 09/28/11 United Seating & Mobility dba Numotion X 0 302 Edmund Street East Peoria IL 61611 (309) 698-32572234830 DME 09/28/11 United Seating & Mobility dba Numotion X 0 335 Eisenhower Ln Lombard IL 60148 (630) 424-0330

80001622 DME 07/01/12 Zoll LifeCor Corp X 0 121 Gamma Drive Pittsburgh PA 15238 (800) 543-3267



Provider #

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51686 Home Hlth 01/01/11 24 Seven Health Care Services Inc. X 0.33 5765 N. Lincoln Ave. Chicago IL 60659-3510 (773) 463-3755 AD 12/01/1352144 Home Hlth 10/01/13 A 2 Z Healthcare Services LLC X 0.33 15347 70th Ct. Orland Park IL 60462-5156 (708) 332-9070 A 11/01/1351516 Home Hlth 03/01/10 A and Z Home Health Care Inc. X 0.33 3232 Ridge Road Lansing IL 60438-3127 (708) 418-1608 A 04/01/1051834 Home Hlth 11/01/11 Abcor Home Care, Inc X 0.33 3201 N. Wilke Road Arlington Heights IL 60004-1573 (847) 670-8424 N 03/01/1351856 Home Hlth 02/01/12 Abundant Home Health Care Inc. X 0.33 545 W Taft Dr. South Holland IL 60473-2030 (708) 331-5575 A 04/01/12

52973 Home Hlth 11/01/13ACCESS (Ambulatory Care Center of Excellence in Surgical Serv. X 0.33 26 W Newell Road Danville IL 61834 (217) 446-2400 A 12/01/13

50433 Home Hlth 02/01/06 AdvanCare Healthcare Service, LLC X 0.33 645 East 170th Street South Holland IL 60473 (708) 392-2000 TE 01/01/1051536 Home Hlth 04/01/10 Advance Home Health Inc X 0.33 800 Roosevelt Road Glen Ellyn IL 60137-5847 (630) 545-0179 A 05/01/1050609 Home Hlth 01/01/14 Advantage Home Health Plus Inc X 0.33 30 E Scranton Ave. Lake Bluff IL 60044-2580 (847) 234-9705 A 01/01/14

5024 Home Hlth 01/01/98 Advantage Home HealthCare, Inc. X 0.33 23950 Northern Illinois Dr. Channahon IL 60410 (815) 467-19059665 Home Hlth 01/01/98 Advocate Home Health Care X 0.33 2311 W. 22nd Street Oak Brook IL 60523 (630) 572-1232

51675 Home Hlth 12/01/10 AIM Home Health X 0.33 3033 Ogden Lisle IL 60532 (630) 946-6693 N & TE 03/01/1452025 Home Hlth 02/01/13 Aledli Home Health Care Inc X 0.33 219 W 55th St. Clarendon Hills IL 60514-1598 (630) 323-0128 A 04/01/13

5429 Home Hlth 10/01/00 Alere Women's and Children's Health, LLC X 0.33 9500 West Bryn Mawr Ave Des Plaines IL 60018 (800) 343-6311 N & AD 05/01/099697 Home Hlth 01/01/98 Alexian Brothers Home Health X 0.33 1515 E. Lake Street Hanover Park IL 60133 (847) 437-5500 R

54768 Home Hlth 01/01/14 All Quality Home Health Care, LLC X 0.33 395 E. Dundee Road Wheeling IL 60090 (224) 676-1470 A 04/01/1451908 Home Hlth 06/01/12 All Solutions Healthcare Inc. X 0.33 1550 E Higgins Road Elk Grove Village IL 60007-1687 (847) 378-8189 A 07/01/1252071 Home Hlth 06/01/13 Allied Professionals Health Care, LLC X 0.33 257 N West Ave. Elmhurst IL 60126-2561 (630) 617-5020 A 07/01/1352053 Home Hlth 04/01/13 AlliedCare Home Health of Illinois LLC X 0.33 380 E Northwest Highway Des Plaines IL 60016-2260 (847) 296-9955 A 05/01/13

9866 Home Hlth 01/01/98 Alterna-Care X 0.33 319 E. Madison 3N Springfield IL 62701 (217) 525-373356761 Home Hlth 11/01/13 Alternacare Home Health SC X 0.33 1920 S Highland St. Lombard IL 60148-6145 (630) 629-7700 A 02/01/1450642 Home Hlth 06/01/07 Amedisys Home Health X 0.33 765 Ela Road Lake Zurich IL 60047 (847) 658-2220 AD 03/01/14


Change Codes:A: NewC: CancelN: Prov. Name P: Prov. NumberR: ReinstateAC: Accrediation CancelAD: AddressCP: Cancel prov # changedPN: Name and Number TE: Telephone NumberTI: Transfer into a classTO: Transfer out of a class 1 Rev. 08-2014

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51458 Home Hlth 12/01/09 Amedisys Home Health of Belleville X 0.33 624 Pierce Blvd. O'Fallon, IL 62269-2579 (618) 825-0170 AD 08/01/1251475 Home Hlth 12/01/09 02/01/12 Amedisys Home Health of Buffalo Grove X 0.33 1425 McHenry Road Buffalo Grove IL 60089-1332 (847) 821-0439 C 01/01/1250647 Home Hlth 06/01/07 02/01/12 Amedisys Home Health of Chicago X 0.33 3519 N. Lincoln Avenue Chicago IL 60657 (773) 665-2060 C 02/01/1250645 Home Hlth 06/01/07 02/01/12 Amedisys Home Health of Hinsdale X 0.33 15 Spinning Wheel Road Hinsdale IL 60521 (630) 654-1641 C 02/01/1251480 Home Hlth 12/01/09 02/01/12 Amedisys Home Health of Illinois X 0.33 680 North Lake Shore Dr. Chicago IL 60611-8702 (312) 768-5130 C 01/01/1250643 Home Hlth 06/01/07 02/01/12 Amedisys Home Health of Joliet X 0.33 2400 Glenwood Ave Joliet IL 60435 (815) 741-9840 C 01/01/1250644 Home Hlth 06/01/07 Amedisys Home Health of Munster X 0.33 8140 Calumet Avenue Munster IN 46321 (219) 836-4979 N 10/01/0950646 Home Hlth 06/01/07 Amedisys Home Health of Oak Park X 0.33 680 North Lake Shore Drive Chicago IL 60611-4466 (708) 660-6300 AD 11/01/1151474 Home Hlth 12/01/09 02/01/12 Amedisys Home Health of Olney X 0.33 821 S. West St Olney IL 62450-1385 (618) 395-1730 C 01/01/1251476 Home Hlth 12/01/09 02/01/12 Amedisys Home Health of Rockford X 0.33 4920 E. State St. Rockford IL 61108-2262 (815) 229-2605 C 01/01/1251634 Home Hlth 09/01/10 American Choice Home Health Care X 0.33 419 Ridge Road Munster IN 46321-1535 (219) 836-8686 A 11/01/1050187 Home Hlth 01/01/98 American Home Health Corp. X 0.33 1460 N. Farnsworth Ave. Aurora IL 60505 (847) 375-0812 PN 05/01/0353762 Home Hlth 12/01/13 Americhoice Health Care Inc X 0.33 950 Skokie Blvd. Northbrook IL 60062 (847) 714-9787 A 01/01/14

5078 Home Hlth 06/30/99 Anchor Health Systems X 0.33 770 N. Main Street Crown Point IN 46307 (219) 622-3500 N 08/01/999791 Home Hlth 01/01/98 Anderson Home Health X 0.33 6800 State Route 162 Merryville IL 62062 (618) 692-1350

52051 Home Hlth 04/01/13 Angel Health Care LLC X 0.33 2625 Butterfield Road Oak Brook IL 60523 (847) 510-5905 A 05/01/1351526 Home Hlth 04/01/10 12/01/13 Angel Touch Home Healthcare Inc. X 0.33 2716 W. Peterson Ave. Chicago IL 60659 (773) 907-0300 C 01/01/1451748 Home Hlth 07/01/11 Apex Home Health Services Inc X 0.33 6160 N Cicero Ave Chicago IL 60646 (773) 202-1948 A 07/01/1150446 Home Hlth 04/01/06 11/01/13 Apria Healthcare X 0.33 81 Remington Road Schaumburg IL 60173 (847) 252-2100 C 02/01/1450030 Home Hlth 10/01/01 Ardent Home Health X 0.33 6124 W. 63rd St. Chicago IL 60638 (773) 229-8400 A 03/01/1150771 Home Hlth 02/01/12 Assure Home Healthcare Inc. X 0.33 7620 Gross Point Road Skokie IL 60077-2612 (847) 297-4444 A 02/01/1253540 Home Hlth 05/01/14 Assurecare Home Health Inc. X 0.33 2295 Valley Creek Drive Elgin IL 60123-2694 (847) 740-1955 A 08/01/14


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51996 Home Hlth 12/01/12 Aster Home Health Services, LLC X 0.33 3101 N. California Ave. Chicago IL 60618 (773) 267-5500 A 01/01/1351749 Home Hlth 07/01/11 At Home Health Inc X 0.33 3344 W Peterson Ave. Chicago IL 60659-3533 (773) 279-9244 A 07/01/1151885 Home Hlth 04/01/12 Atrium Homehealth Systems Inc X 0.33 6600 N Lincoln Ave. Lincolnwood IL 60712-3633 (847) 933-9832 A 05/01/12

5015 Home Hlth 01/01/98 Awakened Alternatives, Inc. X 0.33 3235 Vollmer Road Flossmoor IL 60422-2065 (708) 748-1520 AD 02/01/105428 Home Hlth 09/01/00 Baptist Home Health X 0.33 1003 East 5th Street Metropolis IL 62960 (618) 524-3661 A 11/01/00

51945 Home Hlth 08/01/12 Bay Group Health Care LLC X 0.33 4105 Oakton Street Skokie IL 60076- 3243 (773) 282-9610 A 10/01/1251584 Home Hlth 08/01/10 12/01/13 Benevolent Home Health Care, Inc X 0.33 1038 S LaGrange Road LaGrange IL 60525 (708) 579-3630 C 01/01/1451783 Home Hlth 09/01/11 Bestmed Care Services Ltd. X 0.33 15008 S. Woodlwan Ave Dolton IL 60419-2815 (708) 841-2730 A 10/01/1151741 Home Hlth 04/01/11 Better Care Home Health Inc X 0.33 2860 S. River Road Des Plaines IL 60018 (847) 758-1773 AD 06/01/1251232 Home Hlth 06/01/14 BG Home Health Providers LLC X 0.33 321 W. Dundee Road Buffalo Grove IL 60089 (847) 656-5035 06/01/1452097 Home Hlth 07/01/13 BJC Home Care Services X 0.33 3535 College Drive Alton IL 62002-5009 (314) 273-4000 A 10/01/13

5148 Home Hlth 06/01/01 C G H Home Health Center X 0.33 3010 E. Lynn Blvd. Sterling IL 61081 (815) 622-0836 A 08/17/0150599 Home Hlth 07/01/14 Care For Life Home Health X 0.33 2250 Point Boulevard Elgin IL 60123-7882 (847) 214-3633 A 07/01/1451769 Home Hlth 07/01/11 11/30/13 Caring Nurses Home Health Services Inc X 0.33 5122 W Irving Park Road Chicago IL 60641-2624 (773) 853-0623 C 01/01/14

9869 Home Hlth 01/01/98 Carle Home Care X 0.33 206 A. West Anthony Dr. Champaign IL 61822 (217) 383-34889840 Home Hlth 04/01/99 Centegra Home Health Care X 0.33 4201 Medical Center Dr. McHenry IL 60050 (815) 344-6602 D 03/01/00

51980 Home Hlth 11/01/12 Center of Illinois Home Healthcare Inc. X 0.33 855 E. Golf Road Arlington Heights IL 60005 (847) 437-0774 AD 03/01/1352103 Home Hlth 09/01/13 Central Healthcare Inc X 0.33 4751 S Central Ave. Chicago IL 60638 (708) 924-0500 A 10/01/1350113 Home Hlth 12/01/13 Choicecare Home Health Inc X 0.33 6400 W College Drive Palos Heights IL 60463-1798 (708) 489-0123 A 12/01/1351582 Home Hlth 06/01/10 06/04/13 Classic Home Healthcare Inc X 0.33 3531 W. Fullerton Ave. Chicago IL 60647-2417 (773) 252-2800 C 07/01/1351682 Home Hlth 02/01/11 Client Home Healthcare Inc X 0.33 9705 Southwest Highway Oak Lawn IL 60453 (708) 529-2000 A 03/01/11

9610 Home Hlth 01/01/98 CNS Home Health & Hospice X 0.33 690 E. North Avenue Carol Stream IL 60188 (630) 665-7000 N 06/01/12


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51565 Home Hlth 06/01/10 Comet Home Healthcare Inc. X 0.33 21141 Governors Hwy. Matteson IL 60443 (708) 748-8100 A 07/01/109706 Home Hlth 01/01/98 01/03/11 Community Memorial Hospital Home Care X 0.33 400 Caldwell Staunton IL 62088 (618) 635-2200 C 10/01/13

50111 Home Hlth 01/01/98 Community Alliance Home Health X 0.33 4050 Healthway Drive Aurora IL 60504 (630) 933-7851 PN 09/19/025029 Home Hlth 01/01/98 Community Home Health X 0.33 9042 Columbia Avenue Munster IN 46321 (219) 836-6737

51737 Home Hlth 05/01/11 Complete Home Health Services X 0.33 16234 Prince Drive South Holland IL 60473 (708) 333-1700 A 06/01/119950 Home Hlth 10/19/98 Coram Specialty Infusion Services X 0.33 1471 Business Center Mt. Prospect IL 60056-6082 (847) 294-6422 N 06/01/125047 Home Hlth 03/01/98 Coram Specialty Infusion Services X 0.33 1290 Arrowhead Ct. Crown Point IN 46307-8222 (219) 661-0272 N 06/01/12

52028 Home Hlth 03/01/13 Corlan Home Health Inc X 0.33 415 W Golf Road Arlington Heights IL 6005-3923 (847) 593-0050 A 04/01/1350512 Home Hlth 07/01/06 Cottage Home Health X 0.33 799 N. Henderson St. Galesburg IL 61401 (309) 343-9031 N & AD 03/01/1351563 Home Hlth 06/01/10 Covenant Healthcare Services & Staffing, Inc X 0.33 840 E. 87th St. Chicago IL 60619 (773) 487-9550 A 07/01/1051721 Home Hlth 02/01/11 Cresecent Home Health Agency X 0.33 10 Emerald Terrace Swansea IL 62226 (618) 277-0939 A 05/01/1150157 Home Hlth 02/01/02 Critical Care System X 0.33 655 W. Grand Ave. Elmhurst IL 60126 (630) 833-3427 R 05/01/0951550 Home Hlth 05/01/10 Crystal Home Health Care, LLC X 0.33 825 Midway Drive Willowbrook IL 60527-5549 (630) 964-7500 AD 07/01/1051773 Home Hlth 08/01/11 D & D Home Healthcare Inc X 0.33 101 Royce Road Bolingbrook IL 60440-1429 (630) 759-3422 A 09/01/1151724 Home Hlth 04/01/11 Daughters Divine Home Health Care Agency X 0.33 2653 N. Harlem Ave. Chicago IL 60707 (773) 385-6670 A 05/01/1151884 Home Hlth 04/01/12 DCARE Inc X 0.33 5040 W 190th St. Contry Club Hills IL 60478-5908 (773) 941-4468 A 05/01/12

9698 Home Hlth 09/01/10 Decatur Memorial Hospital Home Health X 0.33 3122 Brentwood Circle Decatur IL 62526 (217) 876-4600 A 10/01/109702 Home Hlth 01/01/98 Delnor Community Hosp. HHA X 0.33 300 Randall Road Geneva IL 60134-4200 (630) 513-0370

51859 Home Hlth 02/01/12 Deluxe Home Health Care LLC X 0.33 6800 Main St. Downers Grove IL 60516-3495 (630) 963-8696 A 04/01/1251462 Home Hlth 12/01/09 Dinamic Health Care LLC X 0.33 1313 Sibley Blvd Calumet City IL 60409 (708) 832-9908 A 01/01/1051393 Home Hlth 06/01/10 Direct Home Healchcare Inc. X 0.33 4001 W. Devon Ave Chicago IL 60646 (773) 777-9271 A 02/01/1152019 Home Hlth 02/01/13 Divine Intervention Healthcare, Inc. X 0.33 4747 Lincoln Mall Drive Matteson IL 60443 (708) 248-7662 A 03/01/13


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51258 Home Hlth 05/01/09 DMJ Home Health Services, Inc. X 0.33 6142 W. Roosevelt Road Oak Park IL 60304 (708) 445-0056 A 06/01/0951643 Home Hlth 09/01/10 Doctors Choice Home Health Agency X 0.33 1133 S. Wabash Ave Chicago IL 60605-2491 (312) 447-0035 A 12/01/1051893 Home Hlth 03/01/12 DR Home Healthcare LLC X 0.33 805 State St. Lemont IL 60439-4691 (630) 243-0527 A 05/01/1251659 Home Hlth 12/01/10 Elite Care at Home X 0.33 568 S Washington St. Naperville IL 60540 (630) 364-7330 A 01/01/1151551 Home Hlth 05/01/10 Elite Healthcare Providers, LLC X 0.33 1000 S. State St. Lockport IL 60441-3956 (815) 836-8100 AD 11/01/12

9875 Home Hlth 01/01/98 Elmhurst Memorial HomeHealth X 0.33 855 N. Church Court Elmhurst IL 60126 (630) 530-120152052 Home Hlth 03/01/13 Encore Home Health Service Inc. X 0.33 2600 W Peterson Ave Chicago IL 60659-4099 (773) 764-2995 A 05/01/1351852 Home Hlth 02/01/12 Epic Home Care Inc. X 0.33 710 E. Ogden Ave. Naperville IL 60563-8633 (630) 470-9668 AD 02/01/1451699 Home Hlth 03/01/11 Essential Preventive Health Care LLC X 0.33 4253 N Milwaukee Ave Chicago IL 60641-1642 (773) 588-0907 AD 03/01/12

5435 Home Hlth 07/18/08 12/01/13 Essex Home Health Services X 0.33 8018 So. Essex Ave Chicago IL 60617 (773) 933-0494 C 01/01/1451854 Home Hlth 02/01/12 12/01/13 Everest Home Healthcare Inc. X 0.33 2644 Dempster St. Park Ridge IL 60068-8431 (847) 699-0804 C 01/01/1451570 Home Hlth 02/01/11 Fairfield Memorial Hospital Home Health X 0.33 303 N W 11th St. Fairfield IL 62837 (618) 842-404951244 Home Hlth 05/01/09 Faith Home Healthcare Inc X 0.33 9919 Roosevelt Road Westchester IL 60154-2772 (708) 681-2853 A 06/01/0951791 Home Hlth 09/01/11 12/01/13 Family Home Care Inc X 0.33 80 Broadway Ave. Mattoon IL 61938-4560 (217) 235-0648 C 01/01/1451427 Home Hlth 10/01/09 Family Home Health Care Professionals Inc. X 0.33 3559 N Cumberland Ave. Chicago IL 60634 (773) 589-0590 A 10/01/0951570 Home Hlth 06/01/10 First Care Healthcare X 0.33 924 Clocktower Springfield IL 62704-6031 (217) 718-4889 A 07/01/1050611 Home Hlth 08/21/09 First Home Health Care Services X 0.33 14730 South Kilbourn Midlothuian IL 60445 (708) 535-8609 A 09/01/0952041 Home Hlth 04/01/13 FMR Home Health Inc X 0.33 10526 W Cermak Westchester IL 60154-5240 (708) 562-0192 A 05/01/1351883 Home Hlth 04/01/12 Forest Home Healthcare Inc. X 0.33 356 Forest Blvd. Park Forest IL 60466-2005 (708) 283-0769 A 05/01/1251357 Home Hlth 08/01/09 Four Seasons Home Healthcare, Inc. X 0.33 6042 Oakton St Morton Grove IL 60053-2702 (847) 966-1616 A 08/01/0951149 Home Hlth 02/01/09 Gateway Regional Home Health X 0.33 2100 Madison Granite City IL 62040 (618) 798-3200 A 05/01/0950210 Home Hlth 06/09/03 04/18/11 Gentiva Health Service (Rockland Island) X 0.33 1600 4th Ave. Street 201 Rock Island IL 61201 (309) 786-3700 C 10/01/13


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51750 Home Hlth 07/01/11 Global Home Health I LLC X 0.33 1940 EW 87th St. Chicago IL 60617-2938 (773) 374-9700 A 07/01/11

51890 Home Hlth 04/01/12Goodhope Healthcare and Home Health Services X 0.33 3631 Municipal Drive McHenry IL 60050 (815) 344-9268 TE 12/01/13

9765 Home Hlth 01/01/98 Gottlieb Mem. Hosp. Home Health X 0.33 701 W. North Avenue Melrose Park IL 60160 (708) 450-49499832 Home Hlth 06/01/10 Graham Hospital Home Health X 0.33 210 W Walnut Canton IL 61520-2444 (309) 647-5240 A 06/01/10

51596 Home Hlth 08/01/10 Guaranteed Medical Services Inc X 0.33 6619 Archer St. Chicago IL 60659-4614 (773) 989-7300 AD 02/01/1451638 Home Hlth 11/01/10 Guardian Angel Home Care Inc X 0.33 7366 N Lincoln Ave Lincolnwood IL 60712 (847) 674-2711 A 12/01/1050320 Home Hlth 09/01/12 Guardian Home Health Care LLC X 0.33 181 Waukegan Road Northfield IL 60093-2700 (847) 441-5020 A 09/01/1251518 Home Hlth 08/30/12 Hands on Wellness Inc X 0.33 1062 Sibley Blvd. Calumet City IL 60409 (708) 832-2228 A 09/01/1251698 Home Hlth 02/01/11 Happy Home Health Care X 0.33 5810 N. Lincoln Ave Chicago IL 60659 (773) 878-7222 A 04/01/1151738 Home Hlth 05/01/11 Harrisburg Medical Center Home Health X 0.33 100 Dr. Warren Tuttle Drive Harrisburg IL 62946-0429 (618) 253-7671 AD 09/01/1250155 Home Hlth 07/01/14 Healing Hands Home Care, Inc. X 0.33 6730 W. Higgins Avenue Chicago IL 60656-2106 (773) 793-3333 R 08/01/1451564 Home Hlth 07/01/10 Healing to Heal Home Healthcare Inc. X 0.33 19900 Governors Drive Olympia Fields IL 60461 (773) 253-4750 A 07/01/1051537 Home Hlth 04/01/10 Healing Touch Home Health Services Inc. X 0.33 123 E. Lake St. Bloomingdale IL 60108-1116 (630) 351-9255 A 05/01/10

9627 Home Hlth 01/01/98 Health Care At Home (Hinsdale Hosp) X 0.33 8230 S. Madison St. Burr Ridge IL 60527 (630) 920-83005142 Home Hlth 05/01/01 Healthtrends, Ltd X 0.33 200 E. Howard DesPlaines IL 60018 (847) 803-0774 A 06/01/01

51688 Home Hlth 02/01/11 Healthy Heart Nurse Inc X 0.33 24560 S Kings Road Crete IL 60417-9631 (708) 367-1300 A 03/01/115039 Home Hlth 01/01/98 11/30/13 Heartland Home Care X 0.33 1260 E. Tremont Hillsboro IL 62049 (217) 532-6111 C 01/01/149864 Home Hlth 01/01/98 11/09/11 Heartland Home Health Care, Inc. X 0.33 20646 S. LaGrange Rd. Frankfort IL 60423-3134 (815) 806-1000 C 11/01/11

50276 Home Hlth 05/01/04 11/09/11 Heartland Home Healthcare and Hospice X 0.33 4415 W. Harrison Hillside IL 60162-1955 (708) 531-9339 C 11/01/11

51808 Home Hlth 10/01/11Hillsboro Rehabilitation & Health Care Center X 0.33 1300 E. Tremont St. Hillsboro IL 62019-1913 (217) 532-6191 N

52066 Home Hlth 05/01/13 Holy Mary Home Health Care Inc X 0.33 2200 S. Main St Lombard IL 60148-5364 (708) 867-8405 A 06/01/13


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50594 Home Hlth 01/10/07 Home Bound Healthcare Inc. X 0.33 1615 Vollmer Road Flossmoor IL 60422-1992 (708) 798-0800 A 10/16/079754 Home Hlth 09/17/98 Home Care Little Company of Mary Hospital X 0.33 2800 W. 95th Street Evergreen Park IL 60805 (708) 229-4663 N 05/01/10

51635 Home Hlth 10/01/10 Home Health Advantage Inc X 0.33 6120 N Milwaukee Ave Chicago IL 60646 (773) 774-7700 AD 06/01/1251886 Home Hlth 03/01/12 Home Health Connections Inc X 0.33 7348 N Monticello Ave Skokie IL 60076-4025 (847) 676-1244 A 05/01/12

5069 Home Hlth 01/01/14 Home Health Of Illinois X 0.33 5061 N Pulaski Rd Chicago IL 60630 (773) 509-1355 R 05/01/149868 Home Hlth 01/01/98 Home Health Services X 0.33 600 N. College Avenue Geneseo IL 61254 (309) 944-4853

51595 Home Hlth 08/01/10 Home Touch Healthcare X 0.33 2010 US Highway 34 Oswego IL 60543-8641 (630) 585-1457 A 08/01/1051723 Home Hlth 04/01/11 Hope Home Health Inc. X 0.33 18456 Poplar Ave. Homewood IL 60430-3463 (708) 647-2929 A 05/01/1151555 Home Hlth 06/01/10 01/01/13 Hyacinth Home Health Inc. X 0.33 4524 Iris Lane Monee IL 60449 (708) 422-4566 C 01/01/1351618 Home Hlth 10/01/10 09/18/13 I Care Home Health Providers, LLC X 0.33 8707 Skokie Blvd. Skokie IL 60077 (847) 745-8424 C 12/01/1351370 Home Hlth 08/01/09 Immanuel Home Care Services,Inc. X 0.33 712 E. 47th St. Chicago IL 60653 (773) 285-2227 A 09/01/09

9899 Home Hlth 09/01/09 Independence Plus Inc X 0.33 720 Enterprise Drive Oak Brook IL 60523-1908 (708) 366-4500 A 09/01/099712 Home Hlth 01/01/98 Ingalls Home Care X 0.33 One Ingalls Drive Harvey IL 60426 (708) 331-0226

50180 Home Hlth 07/28/07 Interim Healthcare X 0.33 12855 S. Cicero Ave. Alsip IL 60803 (708) 383-7320 AD 08/01/1350180 Home Hlth 07/28/07 Interim Healthcare X 0.33 10735 S. Cicero Avenue Oak Lawn IL 60458 (708) 422-2934 AD 09/01/08

9975 Home Hlth 01/01/98 Iroquois Home Health X 0.33 200 Fairman Avenue Watseka IL 60970 (815) 432-617550712 Home Hlth 02/01/08 JCL Home Healthcare, Inc X 0.33 15300 S. Cicero Oak Forest IL 60452 (708) 535-6800 N 05/01/1351766 Home Hlth 08/01/11 Jessifer Home Health Servicess Inc. X 0.33 4738 N Harlem Ave Harwood Heights IL 60706 (708) 867-8310 A 09/01/11

9874 Home Hlth 01/01/98 11/30/13 Kewanee Hosp. Home Health Care X 0.33 1051 W. South Street Kewanee IL 61443 (309) 853-3361 C 12/01/1351841 Home Hlth 12/01/11 Kindred at Home Chicago Home Health X 0.33 7101 N. Cicero Ave Lincolnwood IL 60712-2112 (847) 972-1590 N 09/01/1351849 Home Hlth 02/01/12 Kingsway Home Health Services X 0.33 7115 N Ridge Blvd. Chicago IL 60645-3503 (773) 761-8342 TE 05/01/1352073 Home Hlth 01/01/13 Kishhealth System Home Care X 0.33 2727 Sycamore Road DeKalb IL 60115 (815) 748-8916 A 08/01/13


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9713 Home Hlth 03/01/00 Lake Forest Hospital Home Health X 0.33 660 N. Westmoreland Rd. Lake Forest IL 60045 (847) 535-8788 A 05/12/0051533 Home Hlth 04/01/10 Legen Home Health X 0.33 3405 W. Fullerton Ave Chicago IL 60647-2415 (773) 278-0100 A 05/01/1051626 Home Hlth 10/01/10 Lifeline Home Care LLC X 0.33 15 E. Park Blvd. Villa Park IL 60181-2984 (847) 680-3880 AD 10/01/1351784 Home Hlth 09/01/11 Livingspring Home Health Care Inc. X 0.33 18350 Kedzie Ave. Homewood IL 60430-2759 (708) 960-4767 A 10/01/1152082 Home Hlth 07/01/13 LKB Health Care Ltd X 0.33 355 W Dundee Road Buffalo Grove IL 60089 (847) 947-8900 A 08/01/1351814 Home Hlth 12/01/11 Loving Care Agency Inc X 0.33 2400 E. Devon Avenue Des Plaines IL 60018-4627 (847) 298-0859 A 12/01/11

9729 Home Hlth 01/01/98Loyola University Ct. for Home Care & Hospice X 0.33 2160 S. First Avenue Maywood IL 60153 (708) 531-3642

51099 Home Hlth 12/01/08 MARI Home Healthcare Services, LLC X 0.33 21141 Governors Hwy. Matteson IL 60443 (708) 283-5940 AD 12/01/139831 Home Hlth 06/01/10 Mason District Hospital HHA X 0.33 615 N Promenade St. Havana IL 62644 (309) 543-6137 A 07/01/10

51714 Home Hlth 03/01/11 Maxicare Home Health Services X 0.33 5200 Main St. Skokie IL 60077-2100 (847) 675-6007 A 04/01/1150233 Home Hlth 03/01/08 Maxim Healthcare Services X 0.33 1049 Lake Street Oak Park IL 60301-6708 (866) 286-8773 A 03/10/0850136 Home Hlth 10/01/02 Maximum Home Health Care, Inc. X 0.33 2959 W. 95th Street Evergreen Park IL 60805 (708) 952-1900 A 03/07/0350727 Home Hlth 02/26/08 03/01/13 MCC Healthcare Services Inc X 0.33 9143 S. Kedzie Avenue Evergreen Park IL 60805 (708) 581-7700 C 03/01/13

9657 Home Hlth 06/01/10 McHenry County Department of Health X 0.33 2200 N Seminary Ave. Woodstock IL 60098-2637 (815) 334-4510 A 06/01/1050668 Home Hlth 01/01/08 MDH Home Health Care X 0.33 525 E. Grant Street Macomb IL 61455-3313 (309) 833-4101 A 02/01/0852050 Home Hlth 04/01/13 Medcore Home Health Care Inc X 0.33 1011 E. Touhy Ave Des Plaines IL 60018 (847) 768-6080 A 05/01/1351742 Home Hlth 05/01/11 Medex Home Healthcare Inc. X 0.33 8124 S. Cottage Grove Ave Chicago IL 60619 (773) 488-1400 A 07/01/1151955 Home Hlth 09/01/12 Medi Link Health Services LLC X 0.33 1701 E Woodfield Road Schaumburg IL 60173-5129 (847) 995-9900 A 04/01/1350398 Home Hlth 08/01/05 Medi Plex Professionals X 0.33 10700 Lincoln Trail Fairview Hts IL 62208-2037 (618) 293-6776 A 01/13/06

9651 Home Hlth 04/01/13Medical Professional for Home Health Care Inc. X 0.33 7928 SML King Drive Chicago IL 60617 (773) 487-2400 A 04/01/13

52621 Home Hlth 10/01/13 MedPro Health Providers X 0.33 16335 S Harlem Ave Tinley Park IL 60477-1618 (708) 240-8088 A 01/01/14


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51858 Home Hlth 02/01/12 Medtec Home Health Agency Inc. X 0.33 Medtec Home Health Agency Inc Westchester IL 60154-2563 (708) 681-2009 A 04/01/129688 Home Hlth 04/01/98 Memorial Home Services NFP X 0.33 720 North Bond Street Springfield IL 62702 (217) 523-4113 N 03/01/109980 Home Hlth 01/01/98 Mendota Community Home Health X 0.33 909 Main St. Mendota IL 61342 (815) 539-1421 AD 03/01/129930 Home Hlth 01/01/98 Methodist Med. Ctr. Home Health X 0.33 221 N.E. Glen Oak Peoria IL 61636 (309) 671-8247

50759 Home Hlth 07/30/08 02/29/12 Metrosouth Home Care X 0.33 12935 S. Gregory Blue Island IL 60406 (708) 371-7777 CP 05/01/1251879 Home Hlth 03/01/12 Metrosouth Home Health X 0.33 12935 S Gregory Blue Island IL 60406-2428 (708) 371-7777 P 05/01/1251810 Home Hlth 11/01/11 Midwest Home Health Care of Frankfort LLC X 0.33 8936 Charrington Drive Frankfort IL 60423-9447 (815) 277-2631 A 07/01/12

9715 Home Hlth 01/01/98 03/01/13Mt. Sinai Hospital & Med. Ctr. Home Health Care X 0.33 15th at California Chicago IL 60605 (773) 542-2000 C 03/01/13

52009 Home Hlth 12/01/12 New Beginnings Home Health Care X 0.33 13011 S 104th Ave. Palos Park IL 60464-1512 (708) 671-1700 A 02/01/1352043 Home Hlth 04/01/13 Newage Home Health X 0.33 205 W Grand Ave. Bensenville IL 60106 (847) 679-0541 A 05/01/1351706 Home Hlth 01/01/11 Newsome Home Health Care Agency X 0.33 920 Essington Road Joliet IL 60435-2859 (815) 744-4770 A 04/01/1151502 Home Hlth 02/01/10 Next Level Healthcare Outreach, Inc. X 0.33 2259 E 73rd St Chicago IL 60649-3233 (773) 445-9040 A 03/01/10

50987 Home Hlth 10/01/08Northshore University Health System Home & Hospice Services X 0.33 4901 Searle Parkwy Skokie IL 60077-2919 (847) 475-2001 PN 11/01/08

9714 Home Hlth 01/01/98 Northwest Comm. Hosp. Home Care X 0.33 3060 Salt Creek Lane Arlington Hgts IL 60005 (847) 618-1000 N9662 Home Hlth 02/26/14 Nurses Plus Home HealthCare X 0.33 350 Victory Dr Park Forest IL 60466 (708) 748-1118 A 04/01/14

52072 Home Hlth 06/01/13 Nurture Care Home Health, Inc. X 0.33 125 E. Lake Street Bloomingdale IL 60108 (847) 285-1802 A 07/01/1350511 Home Hlth 06/01/14 O & P Home Health Care X 0.33 4950 Main Street Skokie IL 60089 (847) 329-7050 A 07/01/1451719 Home Hlth 04/01/11 Oasis Medical Services X 0.33 396 S. Kennedy Drive Kankakee IL 60915 (815) 935-4663 N 06/01/12

5028 Home Hlth 01/01/98 Option Health LTD X 0.33 985 Avenue of the Cities Silvis IL 61282-7001 (309) 762-7979 AD 03/01/129958 Home Hlth 01/01/98 Orsini Nursing Agency, Inc. X 0.33 1111 Nicholas Blvd. Elk Grove IL 60007 (847) 734-7373 AD 04/01/099661 Home Hlth 05/01/99 Ottawa Regional Home Health X 0.33 1601Mercury Circle Ottawa IL 61350 (815) 433-6091 N 07/01/11


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9861 Home Hlth 07/01/98 Palos Community Hosp. Home Health X 0.33 15295 E. 127th Street Lemont IL 60439 (630) 257-1111 A 09/01/989923 Home Hlth 01/01/98 Pediatric Serv. of America,Inc. X 0.33 2755-B Curtiss Street Downers Grove IL 60515 (630) 725-13689717 Home Hlth 09/01/10 Pekin Hospital Home Health X 0.33 600 S 13th St. Pekin IL 61554-4936 (309) 347-1151 A 10/01/10

50351 Home Hlth 05/01/05 Phoenix Home Care, LLC X 0.33 200 S. Frontage Road Burr Ridge IL 60527 (630) 321-9400 A 06/07/0551846 Home Hlth 01/01/12 Preferred Home Health Care X 0.33 150 W. South St. Kewanee IL 61441-3749 (918) 252-2000 A 02/01/1251247 Home Hlth 05/01/09 Premier Point Home Health NFP X 0.33 1212 W. Thorndale Ave. Chicago IL 60660-3398 (773) 275-8390 A 06/01/09

5081 Home Hlth 07/03/99 Presence Home Care Services X 0.33 2380 W. Dempster Des Plaines IL 60016 (847) 568-8500 N & AD 10/01/1350150 Home Hlth 01/01/00 Presence Home Care (Elgin) X 0.33 799 South McLean Blvd. Elgin IL 60123 (847) 622-2055 N 10/01/1350160 Home Hlth 01/01/00 Presence Home Care - Joliet X 0.33 1060 Essington Road Joliet IL 60435-8200 (815) 741-7371 N 10/01/1357792 Home Hlth 12/01/13 Presence Home Care - Urbana X 0.33 1501 Interstate Pkwy. Champaign IL 61821-2405 (217) 355-4120 P 05/01/1450162 Home Hlth 01/01/00 Presence Home Care - Urbana X 0.33 1501 Interstate Pkwy. Champaign IL 61821-2405 (217) 355-4120 CP 01/01/1450161 Home Hlth 01/01/00 Presence Home Care Kankakee X 0.33 179 E. Bethel Bourbonnais IL 60914-1456 (815) 937-2475 N 10/01/13

9639 Home Hlth 07/01/14 Private Home Care Unlimited X 0.33 5517 N. Cumberland Chicago IL 60656 (773) 467-6000 A 07/01/1450458 Home Hlth 06/01/06 Proctor Home Care X 0.33 5409 N. Knoxville Ave. Peoria IL 61614 (309) 691-1075 A 12/28/0651785 Home Hlth 09/01/11 Proficient Health Care Services Inc. X 0.33 20316 S. Torrence Ave Lynwood IL 60411-7629 (708) 895-5560 A 10/01/1150163 Home Hlth 01/01/00 Provena Home Health Waukegan X 0.33 222 S. Greenleaf Ave. Waukegan IL 60031 (847) 360-7660 N 06/01/0450070 Home Hlth 01/01/11 Providence at Home HealthCare X 0.33 16300 S Louis Ave. South Holland IL 60473 (708) 331-0400 R 01/01/1151200 Home Hlth 03/01/09 Provider A Care LLC X 0.33 500 E. Higgins Road Elk Grove IL 60007 (773) 326-6860 A 05/01/0951213 Home Hlth 04/01/09 PSA Healthcare X 0.33 16655 Oak Park Ave Tinley Park IL 60477-2313 (708) 429-5551 A 05/01/0951732 Home Hlth 03/01/11 Quality Assured Home Health Inc. X 0.33 3900 W. 95th St. Evergreen Park IL 60805-1901 (708) 529-3823 A 05/01/1151887 Home Hlth 03/01/12 12/01/13 Quality Home Health LLC X 0.33 18525 Torrence Ave. Lansing IL 60438-2891 (708) 983-5137 C 01/01/1454152 Home Hlth 09/01/13 Recover at Home Inc X 0.33 7040 Centennial Drive Tinley Park IL 60477-1649 (708) 444-4170 A 01/01/14


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51096 Home Hlth 01/01/09 Red Bud Regional Home Care X 0.33 1010 Locust St. Red Bud IL 62278 (618) 282-3338 AD 03/01/1251836 Home Hlth 12/01/11 12/01/13 Regal Home Healcare Inc X 0.33 8930 Grosspoint Road Skokie IL 60077-1864 (647) 965-8146 C 01/01/1451329 Home Hlth 06/01/09 Regency Home Health Care PC X 0.33 10448 S. Pulaski Road Oak Lawn IL 60453-4895 (708) 398-4022 A 08/01/0954307 Home Hlth 10/01/13 12/13/13 Regional Home Care X 0.33 517 N Main St Anna IL 62906-1668 (618) 833-2033 C 05/01/1451133 Home Hlth 01/01/09 Regional Home Care Crossroads X 0.33 1009 S 42nd Street Mt Vernon IL 62864 (618) 244-9028 A 05/01/0951711 Home Hlth 02/01/11 Reliable Home Care Providers Inc. X 0.33 430 N Milwaukee Lincolnshire IL 60069 (847) 883-8555 A 04/01/1151073 Home Hlth 10/01/08 Reliance Home Health Care, Inc. X 0.33 1111 Plaza Drive Schaumburg IL 60173 ( 63) 052-9693 A 01/01/09

5016 Home Hlth 01/01/98Residential Home Health (was Edward Home Care) X 0.33 801 S. Washington St. Naperville IL 60540 (630) 527-6840 N 11/01/09

51407 Home Hlth 11/01/09 Residential Home Health IL LLC X 0.33 40 Shuman Blvd. Naperville IL 60563 (630) 527-6830 A 12/01/0950482 Home Hlth 01/01/05 RMC Home Health Care X 0.33 1905 W. Court Street Kankakee IL 60901-3163 (815) 935-3272 PN 03/30/0751597 Home Hlth 08/01/10 Royal Home Health Services Inc X 0.33 14810 S Cicero Ave. Oak Forest IL 60452-1400 (708) 535-0277 A 09/01/1052037 Home Hlth 03/01/13 Sacred Heart Home Health Inc X 0.33 9850 S Cicero Ave Oak Lawn IL 60453-3161 (708) 422-2956 A 05/01/13

9798 Home Hlth 09/01/10 Saint Francis Home Health X 0.33 2265 W. Altorfer Drive Peoria IL 61615 (309) 683-7700 A 12/01/1050350 Home Hlth 02/01/05 Sarah Bush Lincoln Health Center X 0.33 1000 Health Center Dr. Mattoon IL 61938 (217) 258-2525 A 06/07/0551461 Home Hlth 12/01/09 Select Home Care, Inc. X 0.33 2622 W. Peterson Ave. Chicago IL 60659 (773) 338-2230 A 12/01/09

9758 Home Hlth 05/01/14 Shay Healthcare Services, Inc. X 0.33 5730 W. 159th Street Oak Forest IL 60452 (708) 535-4300 A 05/01/149981 Home Hlth 01/01/98 Shelby Memorial Home Health X 0.33 200 S. Cedar Shelbyville IL 62565 (217) 774-4499 TE 10/01/13

4570935 Home Hlth 01/01/98 Sherman Home Care Partners X 0.33 1019 E. Chicago Street Elgin IL 60120 (847) 429-62009770 Home Hlth 01/01/98 06/01/13 Sherman Home Care Partners X 0.33 901 Center Street Elgin IL 60120 (224) 783-6200 C 10/01/139836 Home Hlth 01/01/98 Silver Cross Home Health X 0.33 1200 Maple Road Joliet IL 60432 (815) 740-7124

51762 Home Hlth 06/01/11 Simply Home Health LLC X 0.33 2908 N. Lincoln Chicago IL 60657 (847) 562-0800 AD 02/01/13


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51988 Home Hlth 11/01/12 Someone Who Cares Home Health Care, Inc. X 0.33 1405 S. Harlem Ave. Berwyn IL 60402 (708) 484-8275 A 12/01/1251912 Home Hlth 07/01/12 Soul Care Services Inc X 0.33 2200 E Devon Ave Des Plaines IL 60018-4505 (847) 260-5140 A 08/01/12

9689 Home Hlth 01/01/00 Southwestern Illinois VNA X 0.33 #7 Executive Woods Swansea IL 62226 (618) 236-5800 A 03/01/0051646 Home Hlth 10/01/10 11/30/13 Spectrum Nurses Inc. X 0.33 481 W. Boughton Road Bolingbrook IL 60440-2475 (630) 771-9069 C 01/01/1451366 Home Hlth 08/01/09 12/01/13 Spring Meadows Home Health Care, LLC X 0.33 1835 Broadway Street. Melrose Park IL 60160-2040 (708) 223-8960 C 01/01/14

50671 Home Hlth 01/01/08SSM Health Care at St. Mary's Good Samaritan X 0.33 605 N. 12th Street Mt. Vernon IL 62864-2857 (618) 241-1621

50981 Home Hlth 01/01/08 11/01/13 SSM Home Care of St. Louis X 0.33 20 Junction Dr. Glen Carbon IL 62034 (618) 288-8020 C 12/01/139925 Home Hlth 01/01/98 St. Anthony Ctr. for Home Care X 0.33 5501 E State St. Rockford IL 61108 (815) 921-8700 AD 03/01/149721 Home Hlth 09/01/10 St. Anthonys Hospital Home Health Care X 0.33 915 E 5th St. Alton IL 62002-6434 (618) 463-5683 A 11/01/105144 Home Hlth 05/01/01 St. Anthony's Memorial Home Health X 0.33 503 North Maple Street Effingham IL 62401 (217) 342-2121 A 06/01/019889 Home Hlth 01/01/98 St. Elizabeth Hosp. Home Health X 0.33 211 S. Third Street Belleville IL 62220 (618) 277-93609728 Home Hlth 01/01/98 St. James Home Health X 0.33 1400 Otto Blvd. Chicago Hgts IL 60411 (708) 709-20309862 Home Hlth 09/01/10 St. James Home Health X 0.33 608 N Ladd St. Pontiac IL 61764 (815) 844-6982 C 03/01/139673 Home Hlth 09/01/99 St. John's Home Health Care X 0.33 800 E. Carpenter St. Springfield IL 62702 (217) 525-5641 A 12/01/999850 Home Hlth 01/01/98 St. Margaret Mercy Healthcare X 0.33 5454 Hohman Avenue Hammond IN 46320 (219) 932-23009919 Home Hlth 01/01/98 St. Mary Home Health X 0.33 3205 N. Seminary Street Galesburg IL 61401 (309) 344-3161 AD 12/01/10

52024 Home Hlth 02/01/13 Star Home Health of Waukegan X 0.33 2645 Washington St. Waukegan IL 60085 (847) 360-2220 A 04/01/1351479 Home Hlth 12/01/09 Sunny Hill Home Health Care Inc. X 0.33 10522 S. Cicero Ave. Oak Lawn IL 60453-5200 (708) 424-7025 A 01/01/1051652 Home Hlth 11/01/10 Supportive Home Health X 0.33 1261 Humbracht Circle Bartlett IL 60103-1647 (630) 830-8000 A 01/01/1151722 Home Hlth 04/01/11 Supreme Home Health Care LLC X 0.33 3525 W. Peterson Ave. Chicago IL 60659-5513 (773) 564-9225 A 05/01/1150309 Home Hlth 01/01/05 Swedish American Home Health X 0.33 2550 Charles Street Rockford IL 61110 (815) 391-7500 P 03/08/05


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9638 Home Hlth 01/01/98 Swedish Covenant Hospital HH X 0.33 2965 W. Peterson Ave. Chicago IL 60659 (773) 275-970051097 Home Hlth 12/01/08 Synergy Home Healthcare, inc. X 0.33 2644 Dempster Park Ridge IL 60068-8431 (847) 430-6771 A 02/01/0951690 Home Hlth 02/01/11 Total Health Home Care Services Inc. X 0.33 19150 S Kedzie Flossmoor IL 60422 (708) 799-6022 A 03/01/1152046 Home Hlth 04/01/13 Total Home Healthcare Inc X 0.33 4001 West Devon Chicago IL 60646-4540 (773) 853-2641 A 05/01/1351995 Home Hlth 11/01/12 Transitions Home Care LLC X 0.33 310 7th St. - Valkommen Plaza Rockford IL 61104-1233 (773) 354-4133 A 03/01/13

9691 Home Hlth 01/01/98 Trinity Visinting Nurse Homecare X 0.33 106 19 Avenue Moline IL 61265 (309) 779-7600 W 12/01/0851525 Home Hlth 04/01/10 Tru Care Home Health Inc. X 0.33 4433 W. Touhy Ave Lincolnwood IL 60712-1833 (847) 329-0066 A 04/01/1052049 Home Hlth 04/01/13 Ultra Care Home Health Inc. X 0.33 2400 E Devon Ave. Des Plaines IL 60018 (847) 827-3500 A 05/01/13

9946 Home Hlth 01/01/98 01/03/14 Ultra Care, LLC X 0.33 2100 N. Menheim Rd. Northlake IL 60164 (708) 273-4100 C 03/01/1453815 Home Hlth 03/01/14 UNI Care Home Health Services, Inc. X 0.33 6006 W, 159th Street Oak Forest IL 60452 (708) 444-8445 A 05/01/14

5124 Home Hlth 01/01/07 06/05/13 Union County Hosp. Home Health X 0.33 517 N. Main Street Anna IL 62906-1668 (618) 833-2033 C 09/01/1351745 Home Hlth 07/01/11 United Caregivers Inc. X 0.33 7420 South County Line Road Burr Ridge IL 60527 (630) 655-3204 A 07/01/1151829 Home Hlth 12/01/11 United Medical Care X 0.33 5301 Dempster St Skokie IL 60077 (847) 966-9911 A 01/01/12

5102 Home Hlth 02/22/00 Vanguard Home Care X 0.33 2315 Enterprise Drive Westchester IL 60154-5809 (708) 447-3555 N & AD 12/01/1359539 Home Hlth 10/01/13 Vanguard Health and Wellness X 0.33 1585 Ellinwood Ave DesPlaines IL 60016-4510 (847) 512-7126 A 01/01/1451439 Home Hlth 10/01/09 VCP Home Healthcare Inc. X 0.33 330 N. Madision St. Joliet IL 60435 (815) 725-7391 A 12/01/0951163 Home Hlth 03/01/09 Vintage Healthcare Services, Inc. X 0.33 7 Blanchard Circle Wheaton IL 60187 (630) 517-0191 A 04/01/0951693 Home Hlth 03/01/11 Virgos Home Health Care Inc. X 0.33 8930 Gross Point Road Skokie IL 60077-1854 (847) 965-8914 A 04/01/1152034 Home Hlth 03/01/13 Vision Home Health Care Inc X 0.33 500 W Central Road Mount Prospect IL 60056 (847) 483-9722 A 04/01/1351746 Home Hlth 05/01/11 Vitacare Health Services Inc. X 0.33 4736 Main St. Lisle IL 60532-1986 (630) 324-6592 A 07/01/11

9953 Home Hlth 12/01/13 Vital Home Health Care X 0.33 8051 W 186th St Tinley Park IL 60477 (708) 342-7076 A 12/01/139682 Home Hlth 01/01/98 VNA of Fox Valley X 0.33 400 N. Highland Avenue Aurora IL 60504 (630) 978-2532


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5051 Home Hlth 06/01/98 VNA of Porter County X 0.33 2401 Valley Drive Valparaiso IN 46383 (219) 462-51959687 Home Hlth 01/01/98 VNA of Rockford X 0.33 4223 East State Street Rockford IL 61108 (815) 229-1100

50275 Home Hlth 04/01/04 Walgreens Infusion and Respiratory X 0.33 1226 Michael Dr. Wood Dale IL 60191 (800) 551-9355 N & AD 03/01/1251633 Home Hlth 06/14/10 Walgreens Specialty Infusion X 0.33 2050 S. Finley Road Lombard IL 60148 (630) 495-2777 TE 02/01/1451734 Home Hlth 05/01/14 Wellness Healthcare Partners X 0.33 2338 W. Morse Avenue Chicago IL 60645 (773) 654-1690 A 05/01/1451198 Home Hlth 04/01/09 Wellspring Healthcare Services, Inc. X 0.33 494 W. Boughton Road Bolingbrook IL 60440 (630) 759-7808 A 05/01/0951685 Home Hlth 02/01/11 Whitestar Home Health Agency X 0.33 1495 W King St. Decatur IL 62522-1444 (217) 462-0355 A 03/01/1151747 Home Hlth 06/01/11 Willow Home Care LTD X 0.33 13246 S Route 59 Plainfield IL 60585-9801 (815) 230-3910 A 08/01/1151826 Home Hlth 12/01/11 Wound and Rehab Home Health Care Inc. X 0.33 700 Busse Highway Park Ridge IL 60068-2402 (847) 692-6000 A 12/01/11



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2219836 Home HIT 01/01/98 Accredo Health Inc. X 0.33 650 W. Grand Avenue Elmhurst IL 60126 (630) 993-8830 N 03/07/032221697 Home HIT 01/01/98 Advocate Home Care Products X 0.33 1441 Branding Lane Downers Grove IL 60515 (630) 963-32002232303 Home HIT 07/01/03 Alexian Brothers Home Health X 0.33 1515 Lake Street Hanover Park IL 60133 (847) 956-5464 A 01/13/061630269 Home HIT 03/21/05 Alverno Home Infusion Services X 0.33 1400 Otto Blvd. Chicago Heights IL 60411 (800) 709-2165 A 01/13/062219340 Home HIT 01/01/98 05/01/12 Apria Health Care X 0.33 81 Remmington Road Schaumburg IL 60173 (847) 252-2100 C 05/01/129927598 Home HIT 06/29/01 Care Tech Omnicare Infusion X 0.33 2289 S. Mt. Prospect Rd. Des Plaines IL 60018 (888) 833-1116 PN 08/01/012215464 Home HIT 01/01/98 Caremark Inc. X 0.33 800 Biermann Ct Mt. Prospect IL 60056 (847) 634-74002233041 Home HIT 12/01/06 CNS Home Infusion & Pharmacy X 0.33 690 E. North Avenue Carol Stream IL 60188 (630) 665-7000 A 10/16/07

90000728 Home HIT 01/01/98 Coram Health Care Corp. of IN X 0.33 1290 Arrowhead Ct. Crown Point IN 46307 (219) 661-02721619976 Home HIT 01/01/98 Coram Specialty Infusion Services X 0.33 2022 Glen Park Drive Champaign IL 61821 (217) 356-7900 AL 05/01/121619976 Home HIT 01/01/98 Coram Specialty Infusion Services X 0.33 1471 E. Business Center Dr. Mt. Prospect IL 60056 (847) 294-6422 N 05/01/121629909 Home HIT 03/01/01 Critical Care System, Inc. X 0.33 655 W. Grand Ave. Elmhurst IL 60126 (630) 833-3427 AD & TE 05/01/091670523 Home HIT 01/01/98 02/01/12 Dyna Care IV Supplies X 0.33 18454 Creek Drive Tinley Park IL 60477 (708) 560-7900 C 02/12/122221411 Home HIT 10/01/97 Elmhurst Mem Hosp Home Infusion X 0.33 200 Berteau Avenue Elmhurst IL 60126 (630) 993-5165 A 01/13/061633718 Home HIT 01/01/06 ENH VNA Home Services X 0.33 1603 Orrington Ave. Evanston IL 60201 (847) 475-2001 A 01/13/065871311 Home HIT 03/01/01 Enloes Drug Inc. X 0.33 2106 W. Townline Rd. Peoria IL 61615 (800) 354-0677 A 03/01/01

90001058 Home HIT 03/01/02 Fairmeadows Pharmacy, Inc. X 0.33 800 Macathur Blvd Munster IN 46321 (219) 836-8700 A 07/09/021634500 Home HIT 01/01/13 Health Delivery Mgmt dba Home Infusion X 0.33 610 So Maple Ave Oak Park IL 60304 (708) 660-6200 AL 05/01/13

1634500 Home HIT 01/01/05Health Delivery Mgmt dba Professional Office X 0.33 1725 W. Harrison Chicago IL 60612 (312) 563-2093 A 03/08/05

4970984 Home HIT 01/01/98 Health Options X 0.33 110 S. Market Street Sparta IL 62286 (618) 443-1155 N & TE 11/01/101620277 Home HIT 01/01/98 Heartland Home Hlth Care Hospice X 0.33 2235 Enterprise Drive Westchester IL 60154 (708) 531-99392271395 Home HIT 01/01/98 Heartland Home Infusions X 0.33 500 E. Ogden Avenue Hinsdale IL 60521 (630) 986-43901620054 Home HIT 01/01/98 Home Care Solutions X 0.33 6456 W. Archer Ave. Chicago IL 60638 (773) 229-93001622112 Home HIT 12/01/03 Ingalls Home Care Infusion X 0.33 1 Ingalls Drive Harvey IL 60426 (708) 331-0226 P 12/08/038223260 Home HIT 08/01/01 IV Care LLC X 0.33 65 S. 65th Street Belleville IL 62223 (618) 398-2720 A 10/05/01


Change Codes:A: NewC: CancelN: Prov. Name P: Prov. NumberR: ReinstateAC: Accrediation CancelAD: AddressAL: Additional LocationPN: Name and Number TE: Telephone NumberTI: Transfer into a classTO: Transfer out of a class 1 Rev. 08-2014

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4930043 Home HIT 06/01/01 IV Solutions LLC X 0.33 420 Lake Cook Road Deerfield IL 60015 (847) 945-4444 A 08/17/011671580 Home HIT 01/01/98 Loyola Univ Med Ctr Home Care X 0.33 2160 S. First Avenue Maywood IL 60153 (708) 216-4983 N 02/01/991620168 Home HIT 05/05/03 MacNeal Infusion Therapy X 0.33 3249 S. Oak Park Ave. Berwyn IL 60402 (708) 447-3555 A 01/13/068470416 Home HIT 04/01/98 Memorial Home Care X 0.33 644 N. Second Street Springfield IL 62702 (217) 788-46631634065 Home HIT 01/01/06 Metro Infectious Disease Consultants X 0.33 500 E. Ogden Ave. Hinsdale IL 60521 (630) 654-4201 A 01/13/06

4930161 Home HIT 07/24/01Option Care Enterprises dba Walgreens Infusion Services X 0.33 1226 Michael Drive Wood Dale IL 60191 (800) 551-9355 N/AD 01/01/12

4930161 Home HIT 11/01/10 12/05/13Option Care Enterprises dba Walgreens Infusion Services X 0.33 1221 Arrowhead Cour Crown Point IN 46307 (800) 883-3394 C 04/01/14

3715472 Home HIT 01/15/13Option Health dba Bioscript Infusion Services X 0.33 321 W. Lake St Elmhurst IL 60126 (630) 617-0034 AL 02/01/13

90000733 Home HIT 01/01/98 10/31/10 OptionCare Inc, Indiana X 0.33 9111 Broadway Merrillville IN 46410 (219) 736-1928 C 11/01/103715472 Home HIT 01/01/98 OptionCare Inc, Moline X 0.33 5111 22nd Avenue Moline IL 61265 (309) 762-79792233468 Home HIT 02/04/08 Orsini Pharmaceutical Services X 0.33 2450 Delta Lane Elk Grove Village IL 60007 (847) 879-9550 A 05/01/087215176 Home HIT 07/01/13 OSF Home Infusion Pharmacy X 0.33 2265 W Altorfer Dr Peoria IL 61615 (309) 683-7700 A 08/01/137215176 Home HIT 07/01/13 OSF Home Infusion Pharmacy X 0.33 9951 Rock Cut Crossing Loves Park IL 61111 (309) 692-4731 AL 08/01/131618719 Home HIT 01/01/10 Pri-Med Infusion Services X 0.33 5517 N Cumberland Ave. Chicago IL 60656 (773) 467-6000 A 02/01/104630122 Home HIT 08/01/01 Riverside Home Infusion X 0.33 350 N. Wall Street Kankakee IL 60901 (815) 935-7505 A 11/29/014523585 Home HIT 10/01/02 Sherman Home Care Partners X 0.33 1019 E. Chicago Street Elgin IL 60120 (847) 429-6200 A 01/13/068422219 Home HIT 06/01/01 St. Johns Home Infusion X 0.33 800 E. Carpenter Street Springfield IL 62702 (217) 525-5641 A 08/01/01

10132144 Home HIT 01/12/05 Swedish American Infusion Serv. X 0.33 2550 Charles Street Rockford IL 61108 (815) 391-7575 P 03/08/051670830 Home HIT 01/01/98 10/31/13 Ultra Care X 0.33 2001 Janice Avenue Melrose Park IL 60160 (708) 273-4100 C 05/01/142222890 Home HIT 09/01/00 01/01/11 Valley Infusion Care LLC X 0.33 1815 W. Diehl Road Naperville IL 60563 (630) 355-5630 C 01/01/124520900 Home HIT 01/01/98 VNA of Fox Valley X 0.33 1245 Corporate Blvd Aurora IL 60505 (630) 978-98352234465 Home HIT 05/01/10 Walgreens Specialty Pharmacy X 0.33 2050 S. Finley Road Lombard IL 60148 (630) 495-2777 A 07/01/10


Change Codes:A: NewC: CancelN: Prov. Name P: Prov. NumberR: ReinstateAC: Accrediation CancelAD: AddressAL: Additional LocationPN: Name and Number TE: Telephone NumberTI: Transfer into a classTO: Transfer out of a class 2 Rev. 08-2014

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50417 Hospice 01/31/06 09/11/13 A Touch of Grace Hospice X * 8250 S. Cicero Ave. Burbank IL 60459-1510 (312) 733-2317 C 10/01/139519 Hospice 01/01/98 Advocate Hospice X * 1441 Branding Avenue Downers Grove IL 60515 (630) 963-6800

51558 Hospice 05/01/10 Alexian Brothers Hospice X * 1515 E Lake St. Hanover Park IL 60133-7152 (630) 233-5100 A 06/01/1052042 Hospice 03/01/13 Angels Grace Hospice LLC X * 440 Quadrangle Drive Bolingbrook IL 60440 (888) 444-8341 TE 06/01/1352036 Hospice 04/01/13 APEX Hospice and Palliative Care Inc. X * 2607 W 22nd St Oak Brook IL 60523-4634 (630) 601-1280 N 11/01/1353974 Hospice 11/01/13 BJC Home Care Services X * 1 Professional Dr. Alton IL 62002 (314) 747-8600 A 03/01/1458572 Hospice 11/01/13 Blessing Hospice and Palliative X * 936 Broadway Quincy IL 62301 (217) 223-8400 A 02/01/1450240 Hospice 11/01/03 Blue Skies Hospice X * 2712 169th Street Hammond IN 46323-1433 (219) 554-0688 TE 04/01/1450010 Hospice 07/01/01 BroMenn Hospice X * 1322 S. Main Normal IL 61761-3442 (309) 888-0930 A 10/05/019517 Hospice 01/01/98 Carle Hospice X * 206A West Anthony Dr. Champaign IL 61822-1218 (217) 383-31519571 Hospice 11/01/98 Cass-Schuyler Area Hospice X * 331 S. Main Virginia Il 62691 (217) 452-3057 A 02/01/99

51255 Hospice 05/01/09 CNS Home Health and Hospice X * 690 East North Avenue Carol Stream IL 60188-2172 (630) 665-7000 A 06/01/099525 Hospice 01/01/98 Community Nursing Serv.of DuPage County X * 690 E. North Avenue Carol Stream IL 60188 (630) 665-70009545 Hospice 01/01/98 Decatur Mem. Hosp. Hospice X * 2300 N. Edward St. Decatur IL 62526 (217) 876-6770

51151 Hospice 03/01/09 Family Centered Hospice X * 2171 Executive Drive Addison IL 60101 (630) 317-3300 A 03/01/099544 Hospice 01/01/98 Family Hospice of Belleville Area X * 5110 W. Main Street Belleville IL 62226 (618) 277-1800

50364 Hospice 05/01/05 Fayette County Health Dept X * 416 West Edwards St. Vandalia IL 62471-2707 (618) 283-1044 A 08/03/0551627 Hospice 09/01/10 03/01/13 Franciscan Hospice of Central Illinois X * 608 N Ladd St. Pontiac IL 61764-6982 (815) 844-6982 C 03/01/139546 Hospice 01/01/98 Freeport Memorial Hospice X * 1045 W. Stephenson Freeport IL 61032 (815) 233-6100

51150 Hospice 02/01/09 Gateway Regional Hospice Granite City X * 2100 Madison Granite City IL 62040 (618) 798-3399 PN 05/01/0950223 Hospice 07/01/03 10/01/13 Generations Healthcare, LLC X * 2 Westbrook Corp. Ct Westchester IL 60154 (708) 409-3040 C 10/01/1350209 Hospice 03/01/03 Gentiva Hospice X * 9415 S. Western Ave. Chicago IL 60620 (773) 445-7528 N 05/01/1451569 Hospice 05/01/10 Gentiva Hospice X * 4 Westbrook Corp Ct Westchester IL 60154-5721 (708) 409-3040 N 05/01/1450654 Hospice 08/01/07 Good Heart Hospice, Inc. X * 1550 N. Northwest Hwy. Park Ridge Il 60068 (847) 803-0400 A 02/01/089559 Hospice 09/01/13 Gottlieb Hospice X * 701 W. North Ave Melrose Park IL 60160 (708) 450-5072 R 09/01/13

51451 Hospice 10/01/09 Guardian Healthcare and Hospice X * 1775 Winnetka Road Northfield IL 60093 (847) 446-0000 A 12/01/09


Change Codes:A: NewC: CancelN: Prov. Name P: Prov. NumberR: ReinstateAC: Accrediation CancelAD: AddressCP: Cancel prov # changedPN: Name and Number TE: Telephone NumberTI: Transfer into a classTO: Transfer out of a class 1

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9562 Hospice 01/01/98 Harbor Light Hospice X * 800 Roosevelt Road Glen Ellyn IL 60137 (800) 419-0542 N50409 Hospice 10/01/05 Heartland Home Health Care X * 333 Salem Plaza Fairview Heights IL 62208 (618) 632-0364 N 08/03/069547 Hospice 01/01/98 09/30/11 Heartland Home Health Care and Hospice X * 333 Salem Plaza Fairview Heights IL 62208 (618) 632-0304 C 11/01/11

51571 Hospice 06/01/10 Heartland Home Healthcare & Hospice X * 220 N Smith St. Palatine IL 60067-2477 (847) 272-7338 TE 02/01/1451572 Hospice 06/01/10 Heartland Home Healthcare & Hospice X * 20646 Abbey Wood Ct. Frankfort IL 60423-3166 (815) 806-1000 A 07/01/1050336 Hospice 06/01/06 Heartland Hospice Service X * 363 Financial Court Rockford IL 61107 (815) 227-4917 AD 09/01/1350409 Hospice 10/01/05 Heartland Hospice Services X * 4415 W. Harrison Hillside IL 60162 (708) 234-2800 N 07/01/1051574 Hospice 06/10/10 Heartland Hospice Services X * 1426 10th Ave. . Fulton IL 61252 (815) 589-9900 AD 03/01/1151599 Hospice 08/01/10 Henderson County Health Department Hospice X * 208 W Elm St. Gladstone IL 61437-0220 (309) 627-2812 A 09/01/109512 Hospice 01/01/98 Horizon Hospice X * 833 W. Chicago Avenue Chicago IL 60642 (312) 733-2233 AD 11/01/12

50370 Hospice 05/01/05 Hospice Care of America X * 3815 N. Mulford Rd Rockford IL 61114 (815) 316-2700 AD 05/01/109573 Hospice 02/01/99 Hospice COMPASSUS X * 1640 N. Henderson St. Galesburg IL 61401 (309) 342-3007 N 05/01/129524 Hospice 01/01/98 Hospice of Kankakee Valley X * 482 Main Street N.W. Bourbonnais IL 60914 (815) 393-41419542 Hospice 01/01/98 Hospice of Rock River Valley X * 264 IL Rt. 2 Dixon IL 61021 (815) 288-36739522 Hospice 01/01/98 Hospice of Southeastern IL X * 800 East Locust Olney IL 62450 (618) 395-21319510 Hospice 01/01/98 Hospice of Southern X * 305 S. Illinois Belleville IL 62220 (618) 235-17039537 Hospice 01/01/98 Hospice of the Calumet Area X * 600 Superior Avenue Munster IL 46321 (219) 922-27329536 Hospice 01/01/98 Hospice of the Calumet Area X * 3224 Ridge Road Lansing IL 60438 (708) 895-83329564 Hospice 01/01/98 Hospice of the Wabash Valley X * 600 South First St. Terre Haute IN 47807 (812) 232-7611 N 10/01/009558 Hospice 01/01/98 Illinois Valley Hospice X * 1701 Fourth Street Peru IL 61354 (815) 224-13079530 Hospice 01/01/98 Ingalls Home Hospice X * One Ingalls Drive Harvey IL 60426 (708) 331-0226

53921 Hospice 11/01/13 Integrated Palliative Hospice LLC X * 900 Technology Way Libertyville IL 60048 (847) 549-0588 A 01/01/1450344 Hospice 03/01/05 Iroquois Memorial Hospice X * 200 Fairman Avenue Watseka IL 60970-1644 (815) 432-0185 A 06/07/059518 Hospice 01/01/98 Joliet Area Community Hospice X * 250 Waterstone Circle Joliet IL 60431 (815) 740-41049511 Hospice 01/01/98 Journeycare Inc. X * 405 Lake Zurich Road Barrington IL 60010 (847) 381-5599 N 10/01/139580 Hospice 05/01/01 KishHealth System Hospice X * 2727 Sycamore Road DeKalb IL 60115 (815) 758-8673 N 04/01/14


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50453 Hospice 08/01/06 Lexington Hospice Services, LLC X * 665 W. North Ave. Lombard IL 60148 (630) 652-7900 AD 06/01/129576 Hospice 08/10/99 Lincolnland Hospice of Sarah Bush X * 700 E. Broadway Mattoon IL 61938 (217) 235-4063 N 12/01/99

51489 Hospice 12/01/09 Loving Hands Hospice Inc. X * 6535 N. Olmsted Ave Chicago IL 60631-1414 (773) 775-1536 A 02/01/109538 Hospice 01/01/98 Loyola University Center for HC X * 2160 S. 1st Avenue Maywood IL 60153 (708) 216-4983

50502 Hospice 10/01/06 Maximum Hospice Palliative Care X * 2959 W. 95th Street Evergreen Park IL 60805-2409 (708) 952-1900 A 03/30/079575 Hospice 12/20/09 Memorial Home Services NFP X * 720 N. Bond Street Springfield IL 62702 (217) 523-4113 N 03/01/109539 Hospice 01/01/98 Memorial Hospice X * 855 N. Church Court Elmhurst IL 60126 (630) 530-1201

50758 Hospice 07/30/08 02/29/12 MetroSouth Hospice X * 12935 Gregory Street Blue Island IL 60406 (708) 385-0372 CP 05/01/1251881 Hospice 03/01/12 Metrosouth Hospice X * 12945 Gregory St Blue Island IL 60406 (708) 385-0372 P 05/01/129516 Hospice 11/01/06 Midwest Palliative & Hopice Care Center X * 2050 Clarie Court Glenview IL 60025 (847) 467-7423 N 08/15/07

50365 Hospice 05/01/05 Monarch Hospice & Palliative Care X * 33 W Higgins Road South Barrington IL 60010 (847) 885-1818 AD 04/01/149579 Hospice 04/01/00 Northern Illinois Hospice Assoc. X * 6930 W. Touhy Ave. Niles IL 60714 (815) 398-0500 A 05/12/00

51141 Hospice 12/27/08 Northshore University Health Systen Home and Hospice X * 4901 Searle Parkway Skokie IL 60077-1041 (847) 581-1717 AD 12/01/099521 Hospice 01/01/98 09/25/13 Northwestern Hospital Hospice X * 303 E. Superior Chicago IL 60611 (312) 908-7476 C 12/01/13

51631 Hospice 09/01/10 OSF Hospice X * 3405 N Seminary Galesburg IL 61401-1216 (309) 344-3161 A 12/01/1051630 Hospice 09/01/10 OSF Hospice X * 2265 W Altorfer Drive Peoria IL 61615-1807 (309) 683-7703 A 12/01/1051628 Hospice 09/01/10 OSF Hospice X * 9951 Rock Cut Crossing Loves Park IL 61111-1999 (815) 921-8700 A 12/01/1051629 Hospice 09/01/10 OSF Hospice Eastern Region X * 211 N Landmark Normal IL 61704 (309) 451-5925 AD 05/01/139554 Hospice 01/01/98 Ottawa Regional Hospice X * 1601 Mercury Circle Ottawa IL 61350 (815) 433-6096 N, AD 10/01/09

51212 Hospice 03/01/09 Passages Hospice LLC X * 134 N. McLean Blvd. Elgin IL 60123 (847) 742-8822 A 05/01/0959455 Hospice 11/01/13 Preferred Home Health Care X * 150 W South St Kewanee IL 61443-3749 (309) 853-8000 A 02/01/149565 Hospice 01/01/98 Premier Hospice, Inc. X * 432 N. Halleck DeMotte IN 64310 (219) 324-77339565 Hospice 01/01/98 Premier Hospice, Inc. X * 1600 W. 167th Street Calumet City IL 60409 (708) 868-69609565 Hospice 01/01/98 Premier Hospice, Inc. X * 1205 W. 81st Merrillville IN 46410 (219) 756-76409565 Hospice 01/01/98 Premier Hospice, Inc. X * 1319 Lake Street LaPorte IN 46350 (219) 324-7733

50216 Hospice 01/01/98 Presence Hospice - Elgin X * 799 S. McLean Blvd. Elgin IL 60123 (847) 695-3200 N & AD 10/01/13


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6 Hospice 01/01/98 Presence Saint Mary and Elizabeth Medical Center X * 2233 W. Division Street Chicago IL 60622-3086 (312) 770-2000 PN 10/01/1150607 Hospice 08/01/06 Presense Hospice - Urbana X * 1501 Interstate Pkwy. Champaign IL 61821 (217) 337-2273 N & AD 10/01/1351648 Hospice 09/01/10 Providence Hospice X * 16300 Louis Ave. South Holland IL 60473 (708) 331-0400 A 01/01/1151889 Hospice 03/01/12 Quad County Hospice X * 1 Huber St. Pana IL 62557-1721 (217) 562-6380 A 05/01/129523 Hospice 01/01/98 Rainbow Hospice and Palliative Care X * 444 N. Northwest Hwy. Park Ridge IL 60068 (847) 699-2000 N 12/01/099570 Hospice 08/01/98 Seasons Hospice X * 6400 Shafter Ct Rosemont IL 60018-4989 (847) 759-9449 AD 12/01/09

50047 Hospice 12/01/01 Serenity Hospice and Home X * 1658 So. Route 2 Oregon IL 61061-0462 (815) 732-2499 N & AD 03/01/1250920 Hospice 07/01/08 Southern Illinois Homecare and Hospice X * 129 North 8th Street East St. Louis IL 62201 (618) 482-71479526 Hospice 01/01/98 Spoon River Hospice X * 210 W. Walnut Canton IL 61520 (309) 647-5240

50671 Hospice 01/01/08 SSM Home Care of Illinois X * 605 N. 12th Street Mt. Vernon IL 62864-2857 (618) 241-1612 N 03/01/1150700 Hospice 01/01/08 SSM Hospice of the Good Samaritan X * 605 N. 12th Street Mt. Vernon IL 62864-2857 (618) 241-1621 A 03/10/0850557 Hospice 02/01/10 St. Anthony Hospice X * 203 Franciscan Drive Crown Point IN 46307 (219) 661-5306 A 01/01/139577 Hospice 11/14/99 St. John's Hospital X * 800 E. Carpenter Springfield IL 62769 (217) 544-6464 A 12/01/999513 Hospice 01/01/98 St. Thomas Hospice X * 8230 S. Madison Street Burr Ridge IL 60521 (630) 856-6990 TE 05/01/10

50711 Hospice 05/01/08 The MDH Hospice X * 525 E. Grant Street Macomb IL 61455 (309) 833-4107 A 05/01/0851332 Hospice 08/01/09 Transitions Hospice LLC X * 5100 E State St. Rockford IL 61108 (815) 637-2200 A 08/01/099555 Hospice 01/01/98 05/21/12 Unity Hospice X * 439 East 31st Street Chicago IL 60616 (312) 949-1188 C 06/01/12

50444 Hospice 04/01/06 Unity Hospice of Chicagoland X * 439 E. 31st Street Chicago IL 60616 (312) 949-1188 A 08/03/0650445 Hospice 04/01/06 Unity Hospice of Greater St. Louis X * 907 N. Bluff Road Collinsville IL 62234 (618) 346-1111 A 08/03/0650443 Hospice 04/01/06 Unity Hospice of Northwest IN X * 7863 Broadway Merrillville IN 46410-5554 (219) 769-8648 A 08/03/0650442 Hospice 04/01/06 Unity Hospice of Western IL X * 1201 S. 7th Street Rochelle IL 61068 (815) 561-8866 A 08/03/069550 Hospice 01/01/98 Unity Point Hospice X * 106 19th Ave Moline IL 61265-3700 (309) 779-7600 AD, N 02/01/119578 Hospice 02/01/00 VHS of Illinois Inc. X * 7222 W. Cermak North Riverside IL 60546 (708) 447-3555 PN 05/01/00

51860 Hospice 02/01/12 Vitas Healthcare Corp Midwest X * 8 Executive Dr. Fairview Heights IL 62208-1348 (618) 622-9073 A 04/01/1251250 Hospice 05/01/09 Vitas Healthcare Corp of Illinois X * 8525 W. 183rd St. Tinley Park IL 60487 (708) 781-4400 N & AD 03/01/1250158 Hospice 09/01/04 Vitas Healthcare of Illinois X * 580 Waters Edge Lombard IL 60148 (800) 938-4827 N 08/03/05


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51248 Hospice 05/01/09 Vitas Innovative Hospice Care - Chicago X * 1340 S Damen Ave. Chicago IL 60608-1170 (312) 997-7200 A 06/01/0951249 Hospice 05/01/09 Vitas Innovative Hospice Care - LaSalle X * 105 Marquette St. LaSalle IL 61301-2474 (815) 220-0021 A 06/01/099569 Hospice 06/01/98 VNA Hospice Homcare X * 2401 Valley Drive Valparaiso IN 46383 (219) 462-5195 N & AD 04/01/109532 Hospice 01/01/98 VNA Hospice of Rockford X * 4223 East State St. Rockford IL 61108 (815) 229-11009533 Hospice 01/01/98 VNA of Fox Valley Hospice X * 1245 Corporate Blvd Aurora IL 60505 (630) 978-2532

50217 Hospice 10/01/13 VNA Tip Hospice X * 217 E. Center Drive Alton IL 62002-5946 (618) 467-2080 A 12/01/1350456 Hospice 07/01/06 Waukegan Hospice Corp. X * 2645 Washington St. Waukegan IL 60085 (847) 360-2220 N 03/01/11

A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association*Hospice day charge depends on the type of utilization


Rev. 08-2014

Provider #Provider

TypeEffective

DateCancel

Date Provider Name ClassDay

Charge Address City State Zip TelephoneChange

CodeChange

Date90 IP Metro 01/01/96 Adventist Glen Oaks Hospital I 1 701 Wintrop Ave. Glendale Heights IL 60139-1405 (630) 545-8000 N 05/08/0620 IP Metro 01/01/96 Adventist Hinsdale Hospital I 1 120 North Oak Hinsdale IL 60521-3829 (630) 856-9000 N 05/08/06

50667 IP Metro 01/07/08 Adventist Hospital Bolingbrook I 1 500 Remington Blvd Bolingbrook IL 60440-4906 (630) 312-5000 A 02/01/08399 IP Metro 02/01/99 Adventist LaGrange Memorial Hospital I 1 5101 S. Willow Spring Rd. LaGrange IL 60525-2600 (708) 352-1200 N 05/08/06

16 IP Metro 01/01/95 06/30/10 Advocate Bethany Hospital I 1 3435 W. Van Buren Chicago IL 60624-3359 (773) 878-9700 CP 08/01/1051046 IP Metro 12/01/08 Advocate Condell Medical Center I 1 801 S. Milwaukee Avenue Libertyville IL 60048-3204 (847) 362-2900 A 01/01/0951914 IP Metro 07/01/12 Advocate Hope Children's Hospital I 1 4440 West 95th Street Oak Lawn IL 60453-2600 (708) 684-8000 A 09/01/12

410 IP Metro 11/04/00 Advocate Illinois Masonic Medical Center I 1 836 Wellington Ave. Chicago IL 60657-5147 (773) 975-1600 PN 12/01/0051915 IP Metro 07/01/12 Advocate Lutheran General Childrens I 1 1775 Dempster Street Park Ridge IL 60068-1143 (847) 723-2210 A 09/01/12

63 IP Metro 01/01/96 Advocate Sherman Hospital I 1 1425 N Randall Road Elgin IL 60120-2125 (847) 742-9800 N 07/01/13402 IP Metro 02/01/99 Alexian Brothers Behavioral Health Hospital I 1 1650 Moonlake Blvd. Hoffman Estates IL 60194-1010 (847) 882-1600 N 05/01/99368 IP Metro 01/01/96 Alexian Brothers Medical Center I 1 800 West Biesterfield Road Elk Grove Village IL 60007-3311 (847) 437-5500

50033 IP Metro 10/18/01 Aurora Chicago Lakeshore Hospital I 1 4840 North Marine Drive Chicago IL 60640-4220 (773) 878-9700 PN 01/23/02319 IP Metro 01/01/96 Centega Hospital McHenry I 1 4201 Medical Center Dr. McHenry IL 60050-8409 (815) 344-5000 N 01/01/09

79 IP Metro 01/01/96 Centegra Hospital Woodstock I 1 3701 Doty Road Woodstock IL 60098-3756 (815) 338-2500 N 01/01/09363 IP Metro 01/01/96 Central DuPage Hospital I 1 25 North Winfield Road Winfield IL 60190 (630) 682-1600339 IP Metro 01/01/96 Christ Hosp. & Med. Ctr. - Advocate I 1 4440 West 95th Street Oak Lawn IL 60453-2600 (708) 684-8000

10 IP Metro 01/01/96 Copley Memorial Hospital, Inc. I 1 2000 Ogden Ave. Aurora IL 60504-7222 (630) 978-6200 N 03/01/139 IP Metro 01/01/96 Delnor Community Hospital I 1 300 Randall Road Geneva IL 60134-4200 (630) 208-3000

312 IP Metro 01/01/96 Edward Hospital I 1 801 South Washington Street Naperville IL 60540-7430 (630) 355-045012 IP Metro 01/01/96 Elmhurst Memorial Hospital I 1 200 Berteau Avenue Elmhurst IL 60126-2966 (630) 833-140077 IP Metro 01/01/96 Good Samaritan Hospital - Advocate I 1 3815 Highland Avenue Downers Grove IL 60515-1500 (630) 275-5900

109 IP Metro 01/01/96 Good Shepherd Hospital - Advocate I 1 450 West Highway 22 Barrington IL 60010 (847) 381-9600341 IP Metro 01/01/96 Gottlieb Memorial Hospital I 1 701 West North Ave. Melrose Park IL 60160-1612 (708) 681-3200352 IP Metro 04/16/99 Hartgrove Hospital I 1 5730 West Roosevelt Road Chicago IL 60644 (773) 413-1700 AD 05/01/08

21 IP Metro 01/01/96 Holy Cross Hospital I 1 2701 West 68th Street Chicago IL 60629-1813 (773) 471-800025 IP Metro 01/01/96 Ingalls Memorial Hospital I 1 One Ingalls Drive Harvey IL 60426-3558 (708) 333-230026 IP Metro 01/01/96 Jackson Park Hospital I 1 7531 Stony Island Avenue Chicago IL 60649-3913 (773) 947-7500

Appendix D HMO Illinois, Blue Advantage and Blue Precision MO Contracting Providers

Change Codes:A: NewC: CancelN: Prov. Name P: Prov. NumberR: ReinstateAC: Accrediation CancelAD: AddressCP: Cancel - prov # changedPN: Name and Number TE: Telephone NumberTI: Transfer into a classTO: Transfer out of a class 1

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1 IP Metro 11/01/97 John H. Stroger Jr Hospital Cook County I 1 1835 W. Harrison Street Chicago IL 60612 (312) 633-6000 N 08/31/05160 IP Metro 01/01/96 LaRabida Children's Hospital I 1 6501 Promontory Drive Chicago IL 60649-1326 (773) 363-6700497 IP Metro 01/01/96 Linden Oaks Hospital I 1 852 West Street Naperville IL 60540-6400 (630) 305-5500

30 IP Metro 01/01/96 Little Company of Mary Hospital I 1 2800 West 95th Street Evergreen Park IL 60805-2701 (708) 422-620031 IP Metro 01/01/96 Loretto Hospital I 1 645 South Centeral Chicago IL 600644-5059 (773) 626-4300

50073 IP Metro 01/01/96 Louis A. Weiss Memorial Hospital I 1 4646 North Marine Drive Chicago IL 60640-5700 (773) 878-8700 P 07/09/02500 IP Metro 01/01/96 Loyola University Med. Ctr. I 1 2160 South First Ave. Maywood IL 60153-3304 (708) 216-9000333 IP Metro 01/01/96 Lutheran General Hospital I 1 1775 Dempster Street Park Ridge IL 60068-1143 (847) 723-2210405 IP Metro 02/01/00 MacNeal Memorial Hospital I 1 3249 S. Oak Park Ave. Berwyn IL 60402-3429 (708) 783-9100 P 05/01/00

7 IP Metro 04/12/99 Marianjoy Rehab. Hospital I 1 26 West 171 Roosevelt Rd. Wheaton IL 60187-0795 ( 63) 909-8000 TE 09/01/1235 IP Metro 01/01/96 Mercy Hospital & Medical Center I 1 2525 S. Michigan Ave. Chicago IL 60616 (312) 567-200085 IP Metro 01/01/03 Methodist Hospital of Chicago I 1 5025 N. Paulina St. Chicago IL 60640-2772 (773) 271-9040 A 05/01/03

50874 IP Metro 07/30/08 02/29/12 Metrosouth Medical Center I 1 12935 S Gregory St. Blue Island IL 60406 (708) 597-2000 CP 05/01/1251880 IP Metro 03/01/12 Metrosouth Medical Center I 1 12935 S Gregory St. Blue Island IL 60406-2428 (708) 597-2000 P 05/01/12

38 IP Metro 01/01/96 Mount Sinai Hospital Medical Center I 1 California Avenue at 15th St. Chicago IL 60608-1797 (773) 542-200050135 IP Metro 01/01/03 Neurological and Orthopedic Institute I 1 4501 North Winchester Ave. Chicago IL 60640-5205 (773) 878-4300 AD 05/01/12

15 IP Metro 01/01/96 NorthShore University Healty System I 1 2650 Ridge Avenue Evanston IL 60201-1718 (847) 570-2000 N 10/01/08334 IP Metro 01/01/96 Northwest Community Health Care I 1 800 W. Central Rd. Arlington Hgts IL 60005-2349 (847) 618-1000

87 IP Metro 01/01/96 Northwestern Memorial Hospital I 1 Superior Street at Fairbanks Chicago IL 60611-2914 (312) 908-200039 IP Metro 01/01/96 Norwegian American I 1 1044 North Francisco Ave. Chicago IL 60622-2743 (773) 278-880048 IP Metro 11/01/97 Oak Forest Hospital of Cook County I 1 15900 S. Cicero Ave. Oak Forest IL 60452 (847) 928-4200 A 07/01/9952 IP Metro 01/01/96 Palos Community Hospital I 1 12251 South 80th Ave. Palos Heights IL 60463-1256 (708) 923-4000 TE 11/01/1256 IP Metro 01/01/96 Presence St. Joseph Med. Center I 1 333 North Madison St. Joliet IL 60435 (815) 725-7133 N 10/01/13

200 IP Metro 05/01/02 Presence Convant Medical Center I 1 1400 W. Park Street Urbana IL 61801-2334 (217) 337-2000 N 10/01/1357 IP Metro 01/01/96 Presence Mercy Medical Center I 1 1325 North Highland Ave. Aurora IL 60506-1449 (630) 859-2222 N 12/01/13

316 IP Metro 01/01/96 Presence Our Lady of the Resurrection Med. Ct. I 1 5645 W. Addison Street Chicago IL 60634-4403 (773) 282-7000 N 10/01/1355 IP Metro 01/01/96 Presence Provena St. Joseph Hospital I 1 77 North Airlite Street Elgin IL 60123-4912 (847) 695-3200 N 10/01/13


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269 IP Metro 01/01/96 Presence Resurrection Medical Center I 1 7435 West Talcott St. Chicago IL 60631-3702 (773) 774-8000 N 10/01/13

6 IP Metro 01/01/96Presence Saint Mary and Elizabeth Medical Center I 1 2233 W. Division Street Chicago IL 60622-3043 (312) 770-2000 PN 10/01/11

6 IP Metro 11/01/09Presence Saint Mary and Elizabeth Medical Center I 1 1431 N. Claremont Ave. Chicago IL 60622-1702 (773) 278-2000 PN 10/01/13

51 IP Metro 01/01/96 Presence St. Francis Hospital (Evanston) I 1 355 Ridge Avenue Evanston IL 60202-3328 (847) 492-4000 N 10/01/13415 IP Metro 06/30/01 Presence St. Joseph Hospital I 1 2900 North Lake Shore Dr. Chicago IL 60657-5640 (773) 665-3000 N 10/01/13

60 IP Metro 05/01/02 Presence St. Mary's Hospital I 1 500 W. Court S. Kankakee IL 60901-3661 (815) 937-2490 N 10/01/1393 IP Metro 11/01/97 Provident Hospital of Cook County I 1 500 East 51st Street Chicago IL 60615 (312) 572-2000 A 07/01/99

354 IP Metro 01/01/96 Rehab. Institute of Chicago I 1 345 East Superior St. Chicago IL 60611-3015 (312) 908-6000406 IP Metro 03/01/00 Riveredge Hospital I 1 8311 West Roosevelt Rd. Forest Park IL 60130-2529 (708) 771-7000 PN 05/01/00

45 IP Metro 10/12/05 Roseland Community Hospital I 1 45 West 111th Street Chicago IL 60628 (773) 995-3000 R 01/13/0640 IP Metro 01/01/96 Rush Oak Park Hospital I 1 520 South Maple Ave. Oak Park IL 60304-1022 (708) 383-9300

50462 IP Metro 10/01/06 Rush-University Medical Center I 1 1653 West Congress Parkway Chicago IL 60612-3809 (312) 942-5000 P 08/15/0792 IP Metro 10/01/97 07/19/13 Sacred Heart Hospital I 1 3240 W. Franklin Blvd. Chicago IL 60624 (773) 772-3020 C 12/01/13

353 IP Metro 01/01/96 Schwab Rehabilitation Hospital I 1 1401 S. California Ave. Chicago IL 60608-1612 (773) 522-201051994 IP Metro 01/01/13 Shriners Hospitals for Children I 1 2211 North Oak Park Ave Chicago IL 60707-3351 (773) 622-5400 A 01/01/13

64 IP Metro 01/01/96 Silver Cross Hospital I 1 1900 Silver Cross Blvd. New Lenox IL 60451-9509 (815) 300-1100 TE 08/01/1251076 IP Metro 01/01/09 Skokie Hospital I 1 9600 Gross Point Road Skokie IL 60076-1214 (847) 677-9600 PN 03/01/09

66 IP Metro 01/01/96 South Shore Hospital I 1 8012 S. Crandon Chicago IL 60617-1151 (773) 768-0810259 IP Metro 01/01/96 South Suburban Hospital - Advocate I 1 17800 S. Kedzie Ave. Hazel Crest IL 60429-2029 (708) 799-8000398 IP Metro 02/01/99 St. Alexius Med. Center I 1 1555 N. Barrington Rd. Hoffman Estates IL 60194-1018 (847) 843-2000 A 04/01/99210 IP Metro 01/01/96 St. Anthony Hospital I 1 2875 W. 19th Street Chicago IL 60623-3501 (773) 521-1710

47 IP Metro 01/01/96 St. Bernard Hospital I 1 326 West 64th Street Chicago IL 60621-3119 (773) 962-390050 IP Metro 01/01/96 St. Francis Hospital (Blue Island) I 1 12935 S. Gregory Blue Island IL 60406-2428 (708) 597-2000 PN 09/01/08

404 IP Metro 01/08/00 06/30/11 St. James Hosp.& Health Ctrs-Olympia Fields I 1 20201 S. Crawford Olympia Field IL 60461-0100 (708) 747-4000 CP 08/01/1153 IP Metro 01/01/96 St. James Hospital I 1 1423 Chicago Road Chicago Hgts IL 60411-3400 (708) 756-1000

50061 IP Metro 03/01/14 Streamwood Hospital I 1 1400 E. Irving Park Road Streamwood IL 60107 (630) 837-9000 A 05/01/14


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67 IP Metro 01/01/96 Swedish Covenant Hospital I 1 5145 N. California Ave. Chicago IL 60625-3642 (773) 878-820080 IP Metro 01/01/96 The Ann and Robert H. Lurie Children's Hospital I 1 225 E Chicago Ave. Chicago IL 60611-2605 (312) 227-4000 N 08/01/12

2 IP Metro 01/01/96 Thorek Memorial Hospital I 1 850 West Irving Park Rd. Chicago IL 60613-3011 (773) 525-678065 IP Metro 01/01/96 Trinity Hospital - Advocate I 1 2320 East 93rd Street Chicago IL 60617-3909 (773) 978-2000

401 IP Metro 01/01/96 University of Chgo. Med. Center I 1 5841 Maryland Ave. Chicago IL 60637-1463 (773) 702-1000 TI 10/05/98112 IP Metro 01/01/96 University of Illinois Hospital I 1 1740 West Taylor Street Chicago IL 60612-7232 (312) 996-3892394 IP Metro 01/01/99 Valley West Community Hospital I 1 11 E. Pleasant Sandwich IL 60548 (815) 786-8484 R 02/01/00

51587 IP Metro 08/01/10 VHS West Suburban Medical Center I 1 3 Erie Court Oak Park IL 60302-2510 (708) 383-6200 PN 08/01/1051588 IP Metro 08/01/10 VHS Westlake Hospital Inc I 1 1225 West Lake Street Melrose Park IL 60160-4021 (708) 671-3000 PN 08/01/1050448 IP Metro 07/01/06 Vista Medical Center East I 1 1324 North Sheridan Rd. Waukegan IL 60085-2161 (847) 360-3000 PN 12/28/0650449 IP Metro 07/01/06 Vista Medical Center West I 1 2615 Washington Street Waukegan IL 60085-4916 (847) 249-3900 PN 12/28/06

73 IP Metro 01/01/96 West Suburban Hospital I 1 3 Erie Court Oak Park IL 60302-2510 (708) 383-620074 IP Metro 01/01/96 Westlake Community Hospital I 1 1225 West Lake Street Melrose Park IL 60160-4021 (708) 671-3000



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CodeChange

Date272 IP - State Market 01/01/96 Abraham Lincoln Mem. Hosp. I 1 315 Eighth Street Lincoln IL 62656 (217) 732-2161233 IP - State Market 01/01/96 Alton Memorial I 1 One Memorial Drive Alton IL 62002-6722 (618) 463-739078 IP - State Market 09/01/96 Anderson Hospital I 1 RT 162 & Old Edwardsville Maryville IL 62062 (618) 288-5711

257 IP - State Market 01/01/00 Carlinville Area Hospital I 1 1001 E. Morgan Street Carlinville IL 62626-1448 (217) 854-3141 A 09/01/00822 IP - State Market 04/01/99 Children Hospital of Wisconsin I 1 9000 W. Wisconsin Ave. Milwaukee WI 53226-3518 (414) 266-2000 TI 01/01/01895 IP - State Market 05/01/96 Community Mem. Hospital I 1 W180 N8085 Town Hall Road Menomonee Falls WI 53052 (414) 251-1000131 IP - State Market 01/01/96 Crossroads Comm. Hospital I 1 #8 Doctor's Park Mount Vernon IL 62864-6224 (618) 244-5500810 IP - State Market 01/01/96 Deaconess Hospital I 1 600 Mary Street Evansville IN 47747-0001 (812) 426-3000

52070 IP - State Market 07/01/13 Franciscan Healthcare Munster I 1 701 Superior Ave Munster IN 46321-4037 (219) 922-4200 PN 08/01/1350708 IP - State Market 04/01/08 06/30/13 Franciscan Physicians Hospital LLC I 1 701 Superior Ave Munster IN 46321-4037 (219) 922-4200 CP 08/01/13

838 IP - State Market 01/01/98 Franciscan St. Anthony Health - Crown Point I 1 1201 S. Main Street Crown Point IN 46307 (219) 663-8120 A 01/01/01804 IP - State Market 01/01/96 Franciscan St. Margaret Health - Hammond I 1 5454 Hohman Ave. Hammond IN 46320-1931 (219) 932-2300 N 05/01/11801 IP - State Market 01/01/96 Franciscan St. Margaret Mercy Hospital I 1 U.S. Highway 30 Dyer IN 46311 (219) 865-2141 N 05/01/11

50078 IP - State Market 07/27/07 Franklin Hospital I 1 201 Bailey Lane Benton IL 62812-1969 (618) 439-3161 P 02/01/0814 IP - State Market 01/01/96 Good Samaritan Reg. Health Ctr. I 1 1 Good Samaritan Way Mount Vernon IL 62864-2857 (618) 242-4600 AD 10/01/13

298 IP - State Market 01/01/96 Heartland Regional Medical Center I 1 917 West Main Street Marion IL 62959-1836 (618) 997-5341 N 03/07/03140 IP - State Market 01/01/96 Herrin Hospital I 1 201 S. 14th Street Herrin IL 62948-2857 (618) 942-2171275 IP - State Market 07/01/97 Jersey Community Hospital I 1 400 Maple Summit Road Jerseyville IL 62052-2028 (618) 498-640259 IP - State Market 07/01/96 Kishwaukee Community Hosp. I 1 626 Bethany Road DeKalb IL 60115 (815) 756-1521

212 IP - State Market 08/01/96 06/30/11 Lawrence County Mem. Hospital I 1 2200 West State Lawrenceville IL 62439 (618) 943-1000 C 10/01/1350878 IP - State Market 02/27/09 Lincoln Prairie Behavioral Health Center I 1 5230 S. Sixth St. Springfield, IL 62707 (217) 585-1180 A 04/01/09

237 IP - State Market 01/01/96 Memorial Hosp. of Carbondale I 1 405 West Jackson Street Carbondale IL 62901-2904 (618) 549-0721347 IP - State Market 01/01/96 Memorial Hospital I 1 1900 State Street Chester IL 62233-1116 (618) 826-4581327 IP - State Market 07/01/97 Memorial Hospital Belleville I 1 4500 Memorial Drive Belleville IL 62226-5399 (618) 233-7750175 IP - State Market 01/01/00 Memorial Medical Center I 1 701 N. 1st Street Springfield IL 62702-3757 (217) 788-3000 A 09/01/00196 IP - State Market 01/01/96 Mercy Harvard Hospital I 1 901 Grant Street Harvard IL 60033 (815) 943-5431 N 02/01/08

HMO Illinois, Blue Advantage HMO and Blue Precision Contracting Providers Appendix D

Change Codes:A: NewC: CancelN: Prov. Name P: Prov. NumberR: ReinstateAC: Accrediation CancelAD: AddressCP: Cancel-prov # changedPN: Name and Number TE: Telephone NumberTI: Transfer into a classTO: Transfer out of a class 1

Rev. 08-2014


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CodeChange

Date


880 IP - State Market 04/01/06 Mercy Hospital of Janesville I 1 1000 Mineral Point Avenue Janesville IL 53548-2940 (608) 756-6625 A 12/28/06802 IP - State Market 01/01/96 Methodist Hospital I 1 600 Grant Street Gary IN 46402-6001 (219) 886-4000828 IP - State Market 01/01/96 Methodist Hospital Southlake I 1 8701 Broadway Merrillville IN 46410-7035 (219) 738-5500116 IP - State Market 01/01/03 Methodist Medical Center of Illinois I 1 221 NE Glen Oak Ave. Peoria IL 61636-0001 (309) 672-5522 A 03/07/03230 IP - State Market 01/01/00 Passavant Memorial. Area Hosp. I 1 1600 W. Walnut Jacksonville IL 62650-1136 (217) 245-9551 A 09/01/00240 IP - State Market 01/01/96 Presence United Samaritan Medical Center I 1 812 North Logan Danville IL 61832-3716 (217) 443-5000 N 10/01/13117 IP - State Market 01/01/96 Proctor Community Hospital I 1 5409 North Knoxville Ave. Peoria IL 61614-5016 (309) 691-4702 N 02/01/08

50021 IP - State Market 03/01/02 Red Bud Regional Hospital I 1 325 Spring Street Red Bud IL 62278 (618) 282-3831 A 06/01/04360 IP - State Market 01/01/96 Riverside Medical Development I 1 350 North Wall Street Kankakee IL 60901-2901 (815) 933-1671859 IP - State Market 01/01/96 SSM Rehabilitation Institute I 1 6420 Clayton Road St. Louis MO 63117-1811 (314) 768-5200170 IP - State Market 05/01/13 St Marys Hospital I 1 1800 E. Lake Shore Drive Decatur IL 62521-3810 (217) 464-2966 A 06/01/13371 IP - State Market 04/01/13 St. Anthony Med. Center I 1 5666 East State Street Rockford IL 61108-2425 (815) 226-2000 R 05/01/13806 IP - State Market 01/01/96 St. Catherine Hospital I 1 4321 Fir Street East Chicago IN 46312-3049 (219) 392-1700248 IP - State Market 01/01/96 St. Elizabeth's Hospital I 1 211 S. Third Street Belleville IL 62222 (618) 234-2120174 IP - State Market 05/01/98 St. John's Hospital I 1 800 East Carpenter St. Springfield IL 62769 (217) 544-6464 A 07/01/98204 IP - State Market 08/05/01 St. Joseph Memorial Hosp. I 1 Two South Hospital Drive Murphysboro IL 62966-3337 (618) 684-3156 P 02/27/02181 IP - State Market 10/01/97 St. Joseph’s Hospital I 1 9515 Holy Cross Lane Breese IL 62230-0099 (618) 526-4511251 IP - State Market 07/01/97 St. Joseph's Hospital I 1 12866 Troxler Avenue Highland IL 62249-1698 (618) 654-7421 AD 10/01/13867 IP - State Market 01/01/96 St. Louis Children's Hospital I 1 One Children's Place St. Louis MO 63110-1077 (314) 454-6000870 IP - State Market 01/01/96 St. Mary's Health Center I 1 6420 Clayton Road St. Louis MO 63117-1811 (314) 768-8000803 IP - State Market 01/01/96 St. Mary's Medical Center I 1 1500 South Lake Park Hobart IN 46342 (219) 942-0551

50862 IP - State Market 07/01/08 04/21/11 Surgical Hospital of Munster I 1 7847 Calumet Ave Munster IN 46321-1213 (219) 836-5102 C 10/01/13370 IP - State Market 01/01/96 Swedish American I 1 1400 Charles Street Rockford IL 61104-2224 (815) 968-4400173 IP - State Market 01/01/97 Taylorville Memorial Hospital I 1 201 E. Pleasant Street Taylorville IL 62568 (217) 824-3331 N 10/16/07829 IP - State Market 01/01/96 The Community Hospital I 1 901 MacArthur Blvd. Munster IN 46321-2901 (219) 836-1600

50055 IP - State Market 11/01/06 VanMatre Health South Rehabiliation Hosp I 1 950 S. Mulford Road Rockford IL 61108-4274 (815) 381-8500 A 03/10/08


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59999 IP - State Market 03/01/12 Des Peres Hospital III 3 2345 Dougherty Ferry Road St Louis MO 63122-3313 (314) 966-9100 A 04/01/12

59998 IP - State Market 03/01/12 St. Louis University Hospital III 3 3635 Vista St Louis MO 61110-2539 (314) 577-8000 A 04/01/12



Rev. 08-2014

Provider # Provider Type

Effective Date



Change Code

Change Date

195 Long Term Acute Care 01/01/96 Kindred Chicago Central Hospital I 0.5 4058 W. Melrose Street Chicago IL 60641 (773) 736-7000106 Long Term Acute Care 01/01/96 Kindred Hospital Chicago North I 0.5 2544 W Montrose Chicago IL 60618 (708) 345-8100 AL 09/01/11106 Long Term Acute Care 01/01/96 Kindred Hospital Chicago Northlake I 0.5 365 East North Avenue Northlake IL 60164 (708) 345-8100

51967 Long Term Acute Care 04/01/12 Kindred Hospital Peoria I 0.5 500 W Romeo B Garrett Ave Peoria IL 61605 (309) 680-1500 A 10/01/1251968 Long Term Acute Care 04/01/12 Kindred Hospital Springfield I 0.5 701 North Walnut St. Springfield IL 62702-4931 (217) 528-1217 CP 01/01/14

28 Long Term Acute Care 01/01/96 Kindred Hospital Sycamore I 0.5 225 Edward Street Sycamore IL 60178-2137 (815) 895-2144195 Long Term Acute Care 01/01/96 Kindred Lakeshore I 0.5 6130 No Sheridan Rd Chicago IL 60610 (773) 736-7000 AL 09/01/11340 Long Term Acute Care 01/01/96 Presence Holy Family Medical Center I 0.5 100 North River Road Des Plaines IL 60016-1209 (847) 813-3100 N 10/01/13305 Long Term Acute Care 06/01/97 R M L Specialty Hospital I 0.5 5601 South County Line Rd. Hinsdale IL 60521 (630) 268-4223

51576 Long Term Acute Care 07/01/10 RML Chicago I 0.5 3435 W. Van Buren Chicago IL 60624-3312 (630) 286-400057961 Long Term Acute Care 09/01/13 Vibra Hospital of Springfield LLC I 0.5 701 North Walnut St. Springfield IL 62702-4931 (217) 528-1217 PN 01/01/14

Appendix D


HMO Illinois, Blue Advantage HMO and Blue Precision Contracting Providers

Change Codes:A: NewC: CancelN: Prov. Name P: Prov. NumberR: ReinstateAD: AddressAL: Additional LocationCP: Cancel prov # changedPN: Name and Number TE: Telephone NumberTI: Transfer into a classTO: Transfer out of a class 1

Rev. 08-2014


Effective Date



Change Code

Change Date

51763 Mental Health IOP/PHP 08/01/11 Compass Health Center LLC X 0.25 60 Revere Drive Northbrook IL 60062 (224) 306-1879 A 12/01/1251518 Mental Health IOP/PHP 03/01/11 Insight Psychological Centers LLC X 0.25 333 N. Michigan Ave Chicago IL 60601 (312) 540-9955 A 12/01/1251717 Mental Health IOP/PHP 03/01/11 07/01/13 Insight Psychological Centers LLCV X 0.25 1609 Sherman Avenue Evanston IL 60201-3753 (312) 540-9955 C 07/01/1351715 Mental Health IOP/PHP 03/01/11 04/13/13 Inspire Behavioral Health Centers X 0.25 333 N. Michigan Chicago IL 60601-3901 (312) 540-9955 C 10/01/1351716 Mental Health IOP/PHP 03/01/11 06/04/13 Inspire Behavioral Health Centers X 0.25 1609 Sherman Ave Evanston IL 60201-3753 (312) 540-9955 C 10/01/131813 Mental Health IOP/PHP 12/01/12 Meier Clinics of Illinois P C X 0.25 2100 Manchester Road Wheaton IL 60187-4561 (630) 653-1717 A 12/01/12

51919 Mental Health IOP/PHP 07/01/12 Tazwood Mental Health Center X 0.25 124 S. Chicago St Lincoln IL 62656-2719 (309) 347-5522 A 12/01/1251918 Mental Health IOP/PHP 07/01/12 Tazwood Mental Health Center X 0.25 111 W Washington St East Peoria IL 61611-256- (309) 347-5522 A 12/01/1251928 Mental Health IOP/PHP 07/01/12 Tazwood Mental Health Center X 0.25 3248 Vandever Ave Pekin IL 61554-6257 (309) 347-5522 A 12/01/12

Appendix D


HMO Illinois, Blue Advantage HMO and Blue Precision Contracting Providers

Change Codes:A: NewC: CancelN: Prov. Name P: Prov. NumberR: ReinstateAD: AddressAL: Additional LocationCP: Cancel prov # changedPN: Name and Number TE: Telephone NumberTI: Transfer into a classTO: Transfer out of a class 1

Rev. 08-2014


Effective Date



Change Code

Change Date

2234142 Orthotic & Prosthetic 07/15/09 A Women's Place (mastectomy products) X 0 2222 Maple Avenue Downers Grove IL 60515 (630) 548-9346 AD 05/01/131633525 Orthotic & Prosthetic 01/01/06 Accelerated Prosthetics & Orthotics X 0 2604 Dempster Street Park Ridge IL 60068 (847) 296-7755 A 01/13/061680001 Orthotic & Prosthetic 09/01/01 Acme Orthotic & Prosthetic Lab X 0 6450 College Drive Palos Hts IL 60463 (708) 389-75201680001 Orthotic & Prosthetic 09/01/01 Acme Orthotic & Prosthetic Lab X 0 1836 40 E. 71st Street Chicago IL 60649 (708) 363-0400 A 10/05/011680001 Orthotic & Prosthetic 09/01/01 Acme Orthotic & Prosthetic Lab X 0 3700 W. 203rd Street Olympia Fields IL 60461 (708) 481-11001632158 Orthotic & Prosthetic 06/01/03 American Limb & Orthotic Center X 0 5800 W. Higgins Ave. Chicago IL 60630 (773) 685-4998 A 07/10/034519535 Orthotic & Prosthetic Aurora Orthopedic Laboratories X 0 110 John Street North Aurora IL 60542 (630) 897-63631670063 Orthotic & Prosthetic Ballert Orthopedic X 0 233 E. Erie Street Chicago IL 60611 (312) 787-44001670063 Orthotic & Prosthetic Ballert Orthopedic X 0 139 141 Front Street Wood Dale IL 60191 (630) 694-93051670063 Orthotic & Prosthetic Ballert Orthopedic X 0 125 E. Lake Cook Road Buffalo Grove IL 60089 (847) 459-40061670063 Orthotic & Prosthetic Ballert Orthopedic X 0 5959 S. Cottage Grove Chicago IL 60637 (773) 493-24451670063 Orthotic & Prosthetic Ballert Orthopedic X 0 1725 W. Harrison Chicago IL 60612 (312) 563-27951670063 Orthotic & Prosthetic Ballert Orthopedic of Chicago X 0 1250 N. Mill Street Naperville IL 60563 (630) 637-95401670063 Orthotic & Prosthetic Ballert Orthopedic of Chicago X 0 2445 W. Peterson Ave. Chicago IL 60659 (773) 878-24451618347 Orthotic & Prosthetic Bardach Schoene Company X 0 7318 W. North Ave. Elmwood Park IL 60707 (708) 456-8780

4933426 Orthotic & Prosthetic 11/15/10Barrington Rehab & Sports Physical Therapy (for custom hand orthotics only) X 0 27401 W IL Route 22 Barrington IL 60010 (847) 381-8812 A 02/01/12

5632100 Orthotic & Prosthetic 02/15/06 Benchmark Atlantic Healthcare X 0 5419 Bull Valley Road McHenry IL 60050 (815) 578-0304 A 02/01/081671413 Orthotic & Prosthetic 09/01/06 Best Fit Surgical (Mastectomy products) X 0 11350 S. Cicero Ave. Alsip IL 60803 (800) 585-4580 A 10/16/07

4933008 Orthotic & Prosthetic 11/01/12Betty Schwartz’s Intimate Boutique (Mastectomy products) X 0 1833 Second St Highland Park IL 60035 (847) 432-0220 A 12/01/12

1671478 Orthotic & Prosthetic Bioconcept, Inc. X 0 100 Tower Drive Burr Ridge IL 60527 (630) 986-000780000145 Orthotic & Prosthetic Calumet Orthopedic & Prosthetics Co. X 0 7554 Grand Blvd. Hobart IN 46342 (219) 942-2148

2232921 Orthotic & Prosthetic 02/15/06Castle Orthopeadics & Sports Medicine (for custom hand orthotics only) X 0 2111 Ogden Ave Aurora IL 60504 (630) 978-3800 A 02/01/12

2215274 Orthotic & Prosthetic Central DuPage Orthotics X 0 399 S. Schmale Road Carol Stream IL 60188 (630) 462-7997 N 02/01/08

4933031 Orthotic & Prosthetic 01/01/10Chrysalis Anaplastology & Ocularistry (Ocularist) X 0 23605 N High Ridge Dr Lake Zurich IL 60047 (847) 719-2984 N 11/01/11

7232129 Orthotic & Prosthetic 07/01/06 CPO Services X 0 416 St. Marks Court Peoria IL 61603 (309) 676-2276 A 02/01/082222181 Orthotic & Prosthetic 10/01/06 Cranial Technologies X 0 3633 W. Lake Ave. Glenview IL 60026 (847) 832-9131 A 10/16/07

Appendix D HMO Illinois/Blue Advantage HMO Contracting Providers

Change Codes:A: NewC: CancelN: Prov. Name P: Prov. NumberR: ReinstateAC: Accrediation CancelAD: AddressAL: Additional LocationPN: Name and Number TE: Telephone NumberTI: Transfer into a classTO: Transfer out of a class 1

Rev.08-2014


Effective Date



Change Code

Change Date


2222181 Orthotic & Prosthetic 10/01/06 Cranial Technologies X 0 17W662 Bufferfield Rd. Oakbrook IL 60181 (630) 627-5383 A 10/16/071670232 Orthotic & Prosthetic Dean Prosthetic & Orthotic Service X 0 2530 Crawford Ave. Evanston IL 60201 (847) 475-02415720228 Orthotic & Prosthetic 05/01/08 DJ Peters Orthopedics X 0 908 N. Hershey Bloomington IL 61704 (309) 664-6930 A 07/01/081670158 Orthotic & Prosthetic 07/01/00 Dreher Orthotics and Prosthetics X 0 7350 W. 119th Street Palos Heights IL 60463 (708) 448-6909 A 09/01/001670372 Orthotic & Prosthetic 07/01/00 Dreher Orthotics and Prosthetics X 0 214 Chicago Ave. Oak Park IL 60302 (708) 848-4646 A 09/01/00

4532767 Orthotic & Prosthetic 07/01/09Dreyer Medical Group (Custom Hand Orthotics only) X 0 1221 N Highland Ave Aurora IL 60506 (630) 264-8787 A 03/01/12

2271316 Orthotic & Prosthetic 05/15/12 DuPage Prosthetic-Orthotic Serv. X 0 1100 Sherman Ave Naperville IL 60563 (630) 261-9317 AL 05/01/122271316 Orthotic & Prosthetic DuPage Prosthetic-Orthotic Serv. X 0 121 E. Roosevelt Road Lombard IL 60148 (630) 261-93175621740 Orthotic & Prosthetic 01/01/06 Gullbrandson Orthotics X 0 2615 Three Oak Road Cary IL 60013 (847) 639-4140 A 01/13/06

10021921 Orthotic & Prosthetic 01/01/00 Hanger Prosthetics & Orthotics X 0 7 Bronze Pointe South Belleville IL 62226 (618) 222-703210021921 Orthotic & Prosthetic 01/01/00 Hanger Prosthetics & Orthotics X 0 217 W. Clay Street Troy IL 6224 (618) 667-411410021921 Orthotic & Prosthetic 01/01/00 Hanger Prosthetics & Orthotics (Herrin, IL) X 0 404 Rushing Drive Herrin IL 62948 (618) 997-1451 N 05/12/00

1621056 Orthotic & ProstheticHanger Prosthetics & Orthotics (Orland Park, IL X 0 10719 W. 160th Street Orland Park IL 60467 (708) 364-1570 N 05/12/00

7221371 Orthotic & Prosthetic Hanger Prosthetics & Orthotics (Peoria) X 0 719 N. Kumpf Blvd. Peoria IL 61605 (309) 637-6581 N 05/12/00123424 Orthotic & Prosthetic 01/01/00 Hanger Prosthetics & Orthotics (Quincy) X 0 325 S. Eighth Ave. Quincy IL 62301 (217) 222-3680 N 05/12/00

8423425 Orthotic & Prosthetic 01/01/00 Hanger Prosthetics & Orthotics (Springfield) X 0 1101 No 9th Street Springfield IL 62702 (217) 523-9679 N 05/12/00

90001308 Orthotic & Prosthetic 01/01/00 Hanger Prosthetics & Orthotics (St. John IN) X 0 8626 Wicker Ave. St. John IN 46373 (219) 365-1424 P 02/01/08

1621054 Orthotic & Prosthetic Hanger Prosthetics and Orthotics X 0 1123 Emerson Street Evanston IL 60201 (847) 864-7711 A 02/01/08

4521744 Orthotic & Prosthetic 04/01/98 Hanger Prosthetics and Orthotics X 0 75 Market Place Elgin IL 60123 (847) 695-6955 N 02/01/08

5815197 Orthotic & Prosthetic Hanger Prosthetics and Orthotics X 0 415 N. Main Street Decatur IL 62523 (217) 429-6656

1621374 Orthotic & Prosthetic 01/01/07 Hanger Prosthetics and Orthotics X 0 11231 W Cermak Rd Westchester IL 60154 (708) 447-9860 AL 02/01/13

21622993 Orthotic & Prosthetic 01/01/00 Hanger Prosthetics and Orthotics X 0 4525 W. Lincoln Highway Matteson IL 60443-2318 (708) 755-2200 AD 02/01/11


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Change Code

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4622994 Orthotic & Prosthetic 03/01/00 Hanger Prosthetics and Orthotics X 0 215 N. Convent Street Bourbonnais IL 60914 (815) 937-0241 AD 02/01/12

4521052 Orthotic & Prosthetic Hanger Prosthetics and Orthotics (Aurora) X 0 4255 Westbrook Dr. Aurora IL 60504 (630) 820-5673 N 05/12/00

1621164 Orthotic & Prosthetic 01/01/00Hanger Prosthetics and Orthotics (Crestwood.) X 0 13443 S. Cicero Crestwood IL 60455 (708) 371-9999 N 05/12/00

4921372 Orthotic & Prosthetic 01/01/00 Hanger Prosthetics and Orthotics (Gurnee) X 0 35 Tower Court Street Gurnee IL 60031 (847) 623-6080 N 05/12/00

90001305 Orthotic & Prosthetic 01/01/06Hanger Prosthetics and Orthotics (Hammond) X 0 7324 Indianapolis Blvd Hammond IN 46324 (219) 844-2021 A 02/01/08

1622995 Orthotic & ProstheticHanger Prosthetics and Orthotics (Hazel Crest) X 0 17530 S. Kedzie Avenue Hazel Crest IL 60429-2004 (708) 957-0240 N 05/12/00

9921375 Orthotic & Prosthetic 01/01/00 Hanger Prosthetics and Orthotics (Joliet) X 0 330 N. Madison Street Joliet IL 60435 (815) 744-9944 N 05/12/00

24941542 Orthotic & Prosthetic 01/01/00Hanger Prosthetics and Orthotics (Libertyville) X 0 624 E. Park Ave. Libertyville IL 60048 (847) 367-6572 N 05/12/00

5621373 Orthotic & Prosthetic 01/01/00Hanger Prosthetics and Orthotics (McHenry, IL) X 0 620 S. Route 31 McHenry IL 60050 (815) 344-3070 N 05/12/00

90001309 Orthotic & Prosthetic 01/01/06Hanger Prosthetics and Orthotics (Merrillville, IN) X 0 8691 Connecticut Merrillville IN 46410 (219) 793-1900 A 02/01/08

40021311 Orthotic & Prosthetic 01/01/00 Hanger Prosthetics and Orthotics (Morris) X 0 1051 W. US Route 6 Morris IL 60450 (708) 957-0240 N 05/12/00

2221055 Orthotic & ProstheticHanger Prosthetics and Orthotics (OakBrook, IL) X 0 1S224 Summit Ave. Oak Brook Terrace IL 60181 (630) 620-5333 N 05/12/00

40021341 Orthotic & Prosthetic 01/01/00Hanger Prosthetics and Orthotics (Portage, IN.) X 0 6375 U S Highway 6 Portage IN 46368-5111 (219) 887-5101 N 05/12/00

4122195 Orthotic & Prosthetic 01/01/00Hanger Prosthetics and Orthotics(Mt. Vernon, IL) X 0 301 Main Street Mt Vernon IL 62864 (618) 244-9456 N 05/12/00

1621374 Orthotic & Prosthetic 01/01/00Hanger Prosthetics and Orthotics(North Riverside) X 0 7222 W. Cermak Road North Riverside IL 60546 (708) 447-9860 N 05/12/00

1621376 Orthotic & Prosthetic 01/01/06Hanger Prosthetics and OrthoticsPeterson Ave. (Chg) X 0 4801 W. Peterson Ave. Chicago IL 60646 (773) 777-9494 A 02/01/08


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Change Code

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1606621 Orthotic & Prosthetic 10/01/13Illinois Bone and Joint Institute (Custom Hand Orthotics only) X 0 900 Rand Road Des Plaines IL 60016 (847) 324-3060 A 11/01/13

1618522 Orthotic & Prosthetic 09/01/10 June RR Nichols, Ocularist X 0 1767 E Oakton Street Des Plaines IL 60018 (847) 803-5050 A 09/01/101680007 Orthotic & Prosthetic 10/01/09 Keller Orthotics X 0 2451 N Lincoln Avenue Chicago IL 60614 (773) 929-4700 A 10/01/091618546 Orthotic & Prosthetic Kinetic Orthotics X 0 3958 Rose Ave Western Springs IL 50558 (708) 246-9249 AD 12/01/121618546 Orthotic & Prosthetic Kinetic Orthotics X 0 1815 So Wolf Rd Hillside IL 60162 (708) 246-9249 AL 12/01/121680020 Orthotic & Prosthetic 02/15/06 Koebers Prosthetic and Orthotic Lab X 0 3834 W. Irving Park Road Chicago IL 60618 (773) 539-7333 A 02/01/088932008 Orthotic & Prosthetic 04/01/08 Lavendar N Lace X 0 733 W.. Galena Avenue Freeport IL 61032 (815) 235-1551 A 07/01/081617511 Orthotic & Prosthetic 12/01/00 M.D. Orthotic & Prosthetic Labs, PC X 0 8400 Brookfield Avenue Bellwood IL 60513 (888) 635-2271 AD 08/01/081617511 Orthotic & Prosthetic 12/01/00 M.D. Orthotic & Prosthetic Labs, PC X 0 825 E. Golf Road Arlington Hts IL 60005 (708) 547-9871 11/01/001617511 Orthotic & Prosthetic 12/01/00 M.D. Orthotic & Prosthetic Labs, PC X 0 227 N. Hammes Joliet IL 60435 (815) 741-3722 C 03/01/13

90001246 Orthotic & Prosthetic 01/01/06 M.D. Orthotic & Prosthetic Labs, PC X 0 9111 Broadway Merrillville IN 46410 (219) 736-8896 A 02/01/081617511 Orthotic & Prosthetic 12/01/00 M.D. Orthotic & Prosthetic Labs, PC X 0 10408 So Western Chicago IL 60643 (708) 547-9871 AD 04/01/131617511 Orthotic & Prosthetic 12/01/00 M.D. Orthotic & Prosthetic Labs, PC X 0 4801 W. Petterson Ave. Chicago IL 60646 (708) 547-9871 11/01/001617511 Orthotic & Prosthetic 12/01/00 M.D. Orthotic & Prosthetic Labs, PC X 0 1259 Rickert Drive Naperville IL 60540 (708) 547-9871 11/01/004932217 Orthotic & Prosthetic 09/15/09 Mc Kinney Prosthetics X 0 6475 Washington Street Gurnee IL 60031 (847) 855-0030 A 10/01/095632221 Orthotic & Prosthetic 12/01/06 Mercy Health System Corp X 0 2000 Lake Avenue Woodstock IL 60098 (815) 337-1584 A 10/16/071633178 Orthotic & Prosthetic 01/01/06 Merrick Hopkins Co. X 0 6655 W. Archer Avenue Chicago IL 60638 (773) 586-2222 A 02/01/08

90001304 Orthotic & Prosthetic 03/01/07 Midwest Ocular Prosthetics X 0 450 St. John Road Michigan City IN 46360 (219) 874-7236 A 10/16/071603148 Orthotic & Prosthetic 02/01/13 Midwest Orthotic & Technology Center X 0 5521 N. Cumberland Ave Chicago IL 60656 (773) 930-3770 A 02/01/131671645 Orthotic & Prosthetic 05/01/08 Naturally Yours X 0 7219 Kingery Highway Willowbrook IL 60527 (630) 570-5004 A 05/01/08

10180001 Orthotic & Prosthetic 01/01/98 Northern Prosthetic & Orthotics X 0 2629 Charles Street Rockford IL 61108 (815) 226-0444 A 07/01/991617673 Orthotic & Prosthetic Occupational & Hand Therapy Ltd. X 0 14620 John Humphrey Dr. Orland Park IL 60462 (708) 403-0010

35040141 Orthotic & Prosthetic 03/01/06 Optech Orthotics and Prosthetics X 0 301 E. Hickory Streator IL 61364 (815) 932-8640 A 02/01/084622011 Orthotic & Prosthetic 03/01/06 06/01/12 Optech Orthotics and Prosthetics X 0 138 N. Schuyler Ave. Kankakee IL 60901 (815) 932-8564 CP 07/01/12

39941357 Orthotic & Prosthetic 03/01/06 Optech Orthotics and Prosthetics X 0 121 Springfield Avenue Joliet IL 60435 (815) 741-9700 A 02/01/0891640519 Orthotic & Prosthetic 03/01/06 Optech Orthotics and Prosthetics X 0 18210 S. LaGrange Road Tinley Park IL 60477 (708) 364-9700 A 02/01/08

4632221 Orthotic & Prosthetic 06/01/12 Optech Orthotics and Prosthetics Services X 0 119 E Court St Kankakee IL 60901 (815) 932-8564 P 07/01/124632221 Orthotic & Prosthetic 06/01/12 Optech Orthotics and Prosthetics Services X 0 111 W Jackson Morris IL 60450 (815) 942-4000 AL 07/01/124632221 Orthotic & Prosthetic 06/01/12 Optech Orthotics and Prosthetics Services X 0 200 N Laird Lane Watseka, IL 60970 (815) 932-8564 AL 07/01/12


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4632221 Orthotic & Prosthetic 06/01/12 Optech Orthotics and Prosthetics Services X 0 4900 W 95th St Evergreen Park IL 60805 (866) 990-7832 AL 07/01/124632221 Orthotic & Prosthetic 06/01/12 Optech Orthotics and Prosthetics Services X 0 18016 S Wolf Rd Orland Park IL 60467 (708) 364-9700 AL 07/01/124632221 Orthotic & Prosthetic 06/01/12 Optech Orthotics and Prosthetics Services X 0 121 Springfield Ave Joliet IL 60435 (815) 741-9700 AL 07/01/12

8432043 Orthotic & Prosthetic 01/01/06Orthotic & Prosthetic Associates of Central IL X 0 355 W. Carpenter Street Springfield IL 62702 (217) 789-1450 A 01/13/06

90001222 Orthotic & Prosthetic 01/01/06 Orthotic & Prosthetic Specialists, Inc. X 0 625 Ridge Road Munster IN 46321 (219) 836-8668 A 01/13/061670211 Orthotic & Prosthetic 09/01/01 Patrick G. Adkins Ocularist, LTD X 0 2434 E. Dempster Des Plaines IL 60016 (847) 827-0666 A 07/09/027280003 Orthotic & Prosthetic 03/01/07 Plattner Orthopedic Company X 0 311 W. Romeo B Garrett Ave. Peoria IL 61605 (309) 682-1382 A 02/01/087232049 Orthotic & Prosthetic 03/01/07 Plattner Pedorthic Services X 0 311 W. Romeo B. Garrett Ave. Peoria IL 61605 (309) 682-1382 A 02/01/088232326 Orthotic & Prosthetic 12/01/12 Prosthetic and Orthotic Care, Inc X 0 13 Executive Drive Fairview Heights, IL 62208 (618) 212-0006 A 12/01/129933360 Orthotic & Prosthetic 03/25/13 Rinella Orthotics X 0 1890 Silver Cross Blvd New Lenox IL 60451 (815) 717-8970 A 04/01/131670147 Orthotic & Prosthetic 01/01/06 Robert B. Scott Ocularists X 0 111 N. Wabash Avenue Chicago IL 60602 (312) 782-3558 A 01/13/066020694 Orthotic & Prosthetic Roberta Lovely Ladies Boutique X 0 603 W. Delmar Avenue Alton IL 62002 (618) 467-0640

10180002 Orthotic & Prosthetic Rockford Orthopedic Appliance X 0 422 East State Street Rockford IL 61104 (815) 965-775990000081 Orthotic & Prosthetic Saint Giles Orthopedic Lab. X 0 8035 Euclid Avenue Munster IN 46321 (219) 836-2251 R 02/01/08

1680014 Orthotic & Prosthetic Scheck & Siress Prosthetics, Inc. X 0 1725 W. Harrison Street Chicago IL 60612 (312) 942-20111680014 Orthotic & Prosthetic Scheck & Siress Prosthetics, Inc. X 0 1551 Bond Street Naperville IL 60563 (630) 637-46381680014 Orthotic & Prosthetic Scheck & Siress Prosthetics, Inc. X 0 6629 W. Lincoln Hwy. Schereville IN 46375 (219) 864-95021680014 Orthotic & Prosthetic Scheck & Siress Prosthetics, Inc. X 0 2101 Waukegan Road Bannockburn IL 60015 (847) 444-06901680014 Orthotic & Prosthetic Scheck & Siress Prosthetics, Inc. X 0 2530 Crawford Ave. Evanston IL 60201 (847) 475-7080 AL 09/01/111680014 Orthotic & Prosthetic Scheck & Siress Prosthetics, Inc. X 0 401 Harrison Street Oak Park IL 60304 (708) 383-22571680014 Orthotic & Prosthetic Scheck & Siress Prosthetics, Inc. X 0 8641 W. 95th Street Hickory Hills IL 60457 (708) 599-83361680014 Orthotic & Prosthetic Scheck & Siress Prosthetics, Inc. X 0 1740 W. Taylor Street Chicago IL 60612 (312) 996-64501680014 Orthotic & Prosthetic Scheck & Siress Prosthetics, Inc. X 0 1S376 Summit Ave. Oakbrook Terrace IL 60181 (630) 464-03921680014 Orthotic & Prosthetic Scheck & Siress Prosthetics, Inc. X 0 617 E. Golf Road Arlington Heights IL 60005 (847) 437-39291680014 Orthotic & Prosthetic Scheck & Siress Prosthetics, Inc. X 0 2552 N. Clark Street Chicago IL 60614 (773) 472-36631670563 Orthotic & Prosthetic Schwartz’s Intimate Apparel X 0 161 Skokie Valley Rd Highland Park IL 60035 (847) 251-1118 AD 03/01/121629675 Orthotic & Prosthetic 03/01/12 Second Act (Mastectomy products) X 0 3020 N Lincoln Ave Chicago IL 60657 (773) 525-2228 A 04/01/12

8432146 Orthotic & Prosthetic 03/01/06SIU Physicians & Surgeons (for custom hand orthotics only) X 0 747 N Rutledge St Springfield IL 62702 (217) 545-0885 A 02/01/12


Rev.08-2014


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Change Code

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1604224 Orthotic & Prosthetic 02/01/14 Smithotics, LLC X 0 2353 Hassell Road Hoffman Estates IL 60169 (224) 653-8411 A 01/01/149932112 Orthotic & Prosthetic 04/01/03 Stellar Orthotics Prothetics, Ltd. X 0 9631 Gross Point Road Skokie IL 60076 (847) 410-2751 A 07/10/039932112 Orthotic & Prosthetic 04/01/03 Stellar Orthotics Prothetics, Ltd. X 0 815 N. Larkin Avenue Joliet IL 60435 (815) 207-4200 A 07/10/031616246 Orthotic & Prosthetic Suburban Orthotics & Prosthetics, Inc. X 0 450 Lee Street DesPlaines IL 60016 (847) 298-7107

10132122 Orthotic & Prosthetic 10/01/10 The Inspiration (Mastectomy products) X 0 2591 N Mulford Rd. Rockford IL 61114 (815) 639-9251 A 11/01/101617119 Orthotic & Prosthetic 09/01/99 Woodfield Ortho Services X 0 37W002 S. Mooseheart Rd. Batavia/Mooseheart IL 60539 (630) 844-9969 A 09/01/991617119 Orthotic & Prosthetic 09/01/99 Woodfield Ortho Services X 0 2155 Stonington Ave. Hoffman Estates IL 60195 (847) 885-6100 A 09/01/99



Rev.08-2014


Effective Date



Change Code

Change Date

4933426 Orthotic & Prosthetic 11/15/10Barrington Rehab & Sports Physical Therapy (for custom hand orthotics only) X 0 27401 W IL Route 22 Barrington IL 60010 (847) 381-8812

2232921 Orthotic & ProstheticCastle Orthopeadics & Sports Medicine (for custom hand orthotics only) X 0 2111 Ogden Ave Aurora IL 60504 (630) 978-3800

4933031 Orthotic & Prosthetic 01/01/10 Chrysalis Anaplastology & Ocularistry (Ocularist) X 0 23605 N High Ridge Dr Lake Zurich IL 60047 (847) 719-29844532767 Orthotic & Prosthetic 07/01/09 Dreyer Medical Group (Custom Hand Orthotics only) X 0 1221 N Highland Ave Aurora IL 60506 (630) 264-87874521744 Orthotic & Prosthetic Hanger Prosthetics and Orthotics - Elgin X 0 75 Market Place Elgin IL 60123 (847) 695-6955

90001305 Orthotic & Prosthetic Hanger Prosthetics and Orthotics - Hammond X 0 7324 Indianapolis Blvd Hammond IN 46324 (219) 844-2021 1621374 Orthotic & Prosthetic 01/01/07 Hanger Prosthetics and Orthotics - Westchester X 0 11231 W Cermak Rd Westchester IL 60154 (708) 447-98604521052 Orthotic & Prosthetic Hanger Prosthetics and Orthotics - Aurora X 0 4255 Westbrook Dr. Aurora IL 60504 (630) 820-5673 4622994 Orthotic & Prosthetic 03/01/00 Hanger Prosthetics and Orthotics - Bourbonnais X 0 215 N. Convent Street Bourbonnais IL 60914 (815) 937-0241 1621164 Orthotic & Prosthetic Hanger Prosthetics and Orthotics - Creastwood X 0 13443 S. Cicero Crestwood IL 60455 (708) 371-9999 1621054 Orthotic & Prosthetic Hanger Prosthetics and Orthotics - Evanston X 0 1123 Emerson Street Evanston IL 60201 (847) 864-77114921372 Orthotic & Prosthetic Hanger Prosthetics and Orthotics - Gurnee X 0 35 Tower Court Street Gurnee IL 60031 (847) 623-6080 1622995 Orthotic & Prosthetic Hanger Prosthetics and Orthotics - Hazel Crest X 0 17530 S. Kedzie Avenue Hazel Crest IL 60429 (708) 957-0240 9921375 Orthotic & Prosthetic Hanger Prosthetics and Orthotics - Joliet X 0 330 N. Madison Street Joliet IL 60435 (815) 744-9944

24941542 Orthotic & Prosthetic Hanger Prosthetics and Orthotics - Libertyville X 0 624 E. Park Ave. Libertyville IL 60048 (847) 367-6572 40031364 Orthotic & Prosthetic Hanger Prosthetics and Orthotics - Lincolnshire X 0 300 Village Green Dr, Lincolnshire IL 60069 847-478-815421622993 Orthotic & Prosthetic Hanger Prosthetics and Orthotics - Matteson X 0 4525 W. Lincoln Highway Matteson IL 60443 (708) 755-2200

7221371 Orthotic & Prosthetic Hanger Prosthetics and Orthotics - McHenry X 0 620 S Route 31, McHenry IL 60050 815-344-307090001309 Orthotic & Prosthetic Hanger Prosthetics and Orthotics - Merrillville, IN X 0 8691 Connecticut Merrillville IN 46410 (219) 793-1900

1621374 Orthotic & Prosthetic Hanger Prosthetics and Orthotics - North Riverside X 0 7222 W. Cermak Road North Riverside IL 60546 (708) 447-9860 2221055 Orthotic & Prosthetic Hanger Prosthetics and Orthotics - Oak Brook X 0 1S224 Summit Ave. Oak Brook Terrace IL 60181 (630) 620-5333 1621056 Orthotic & Prosthetic Hanger Prosthetics and Orthotics - Orland Pk X 0 10719 W. 160th Street Orland Park IL 60467 (708) 364-1570

40021341 Orthotic & Prosthetic Hanger Prosthetics and Orthotics - Portage, IN X 0 6375 U S Highway 6 Portage IN 46368 (219) 887-5101 90001308 Orthotic & Prosthetic Hanger Prosthetics and Orthotics - St John IN X 0 8626 Wicker Ave. St. John IN 46373 (219) 365-1424

1621376 Orthotic & Prosthetic 01/01/06Hanger Prosthetics and Orthotics Peterson Ave.- Chicago X 0 4801 W. Peterson Ave. Chicago IL 60646 (773) 777-9494

Appendix D Blue Precision HMO Contracting Providers


Rev.08-2014


Effective Date



Change Code

Change Date

Appendix D Blue Precision HMO Contracting Providers

1606621 Orthotic & Prosthetic 10/01/13Illinois Bone & Joint Institute CHT (Custom Hand Orthotics only) X 0 900 Rand Rd, Des Plaines IL 60016 847-324-3060

1618522 Orthotic & Prosthetic 09/01/10 June RR Nichols, Ocularist X 0 1767 E Oakton Street Des Plaines IL 60018 (847) 803-505090001304 Orthotic & Prosthetic Midwest Ocular Prosthetics X 0 450 St. John Road Michigan City IN 46360 (219) 874-723610180001 Orthotic & Prosthetic 01/01/98 Northern Prosthetic & Orthotics X 0 2629 Charles Street Rockford IL 61108 (815) 226-0444

1670211 Orthotic & Prosthetic 09/01/01 Patrick G. Adkins Ocularist, LTD X 0 2434 E. Dempster Des Plaines IL 60016 (847) 827-06661670147 Orthotic & Prosthetic Robert B. Scott Ocularists X 0 111 N. Wabash Avenue Chicago IL 60602 (312) 782-3558

10180002 Orthotic & Prosthetic Rockford Orthopedic Appliance X 0 422 East State Street Rockford IL 61104 (815) 965-775910132122 Orthotic & Prosthetic 10/01/10 The Inspiration (Mastectomy products) X 0 2591 N Mulford Rd. Rockford IL 61114 (815) 639-9251



Rev.08-2014

Provider #

Provider Type

Effective Date



Change Code

Change Date

272 OP Surgery 01/01/96 Abraham Lincoln Mem. Hosp. I 1 315 Eighth Street Lincoln IL 62656 (217) 732-216190 OP Surgery 01/01/98 Adventist Glen Oaks Hospital I 1 701 Wintrop Ave. Glendale Heights IL 60139-1405 (630) 545-8000 N 05/08/0620 OP Surgery 01/01/98 Adventist Hinsdale Hospital I 1 120 North Oak Hinsdale IL 60521-3829 (630) 856-9000 N 05/08/06

50667 OP Surgery 01/07/08 Adventist Hospital Bolingbrook I 1 500 Remington Blvd Bolingbrook IL 60440-4906 (630) 312-5000 A 02/01/08399 OP Surgery 02/01/99 Adventist LaGrange Memorial Hospital I 1 5101 S. Williow Spring Rd. LaGrange IL 60525-2600 (708) 352-1200 N 05/08/06

16 OP Surgery 01/01/95 06/30/10 Advocate Bethany Hospital I 1 3435 W. Van Buren Chicago IL 60624-3359 (773) 265-7700 CP 08/01/1051046 OP Surgery 12/01/08 Advocate Condell Medical Center I 1 801 S. Milwaukee Avenue Libertyville IL 60048-3204 (847) 362-2900 A 01/01/0951914 OP Surgery 07/01/12 Advocate Hope Children's Hospital I 1 4440 West 95th Street Oak Lawn IL 60453-2600 (708) 684-8000 A 09/01/12

410 OP Surgery 11/04/00 Advocate Illinois Masonic Medical Center I 1 836 Wellington Ave. Chicago IL 60657-5147 (773) 975-1600 PN 12/01/0051915 OP Surgery 07/01/12 Advocate Lutheran General Childrens I 1 1775 Dempster Street Park Ridge IL 60068-1143 (847) 723-2210 A 09/01/12

63 OP Surgery 01/01/98 Advocate Sherman Hospital I 1 1425 N Randall Road Elgin IL 60123 (847) 742-9800 N 07/01/13402 OP Surgery 02/01/99 Alexian Brothers Behavioral Health Hospital I 1 1650 Moonlake Blvd. Hoffman Estates IL 60194-1010 (847) 882-1600 N 05/01/99368 OP Surgery 01/01/98 Alexian Brothers Medical Center I 1 800 West Biesterfield Road Elk Grove IL 60007-3311 (847) 437-5500

78 OP Surgery 09/01/96 Anderson Hospital I 1 RT 162 & Old Edwardsville Maryville IL 62062 (618) 288-5711257 OP Surgery 01/01/00 Carlinville Area Hospital I 1 1001 E. Morgan Street Carlinville IL 62626-1448 (217) 854-3141 A 09/01/00319 OP Surgery 05/01/99 Centegra Hospital McHenry I 1 4201 Medical Center Dr. McHenry IL 60050-8409 (815) 344-5000 N 01/09/09

79 OP Surgery 05/01/99 Centegra Hospital Woodstock I 1 3701 Doty Road Woodstock IL 60098-3756 (815) 338-2500 N 01/01/09363 OP Surgery 01/01/98 Central DuPage Hospital I 1 25 North Winfield Road Winfield IL 60190 (630) 682-1600822 OP Surgery 04/01/99 Children's Hosp. of Wisconsin I 1 9000 W. Wisconsin Ave. Milwaukee WI 53226-3518 (414) 266-2000 01/01/01339 OP Surgery 01/01/98 Christ Hospital I 1 4440 West 95th Street Oak Lawn IL 60453-2600 (708) 684-8000895 OP Surgery 05/01/96 Community Mem. Hospital I 1 W180 N8085 Town Hall Road Menomonee Falls WI 53052 (414) 251-1000

10 OP Surgery 01/01/98 Copley Memorial Hospital, Inc. I 1 2000 Ogden Ave. Aurora IL 60504-7222 (630) 978-6200 N 03/01/139 OP Surgery 01/01/98 Delnor Community Hospital I 1 300 Randall Road Geneva IL 60134-4200 (630) 208-3000

312 OP Surgery 01/01/98 Edward Hospital I 1 801 South Washington Street Naperville IL 60540-7430 (630) 833-140012 OP Surgery 01/01/98 Elmhurst Memorial Hospital I 1 200 Berteau Avenue Elmhurst IL 60126-2966 (331) 221-1000 TE 03/01/13

52070 OP Surgery 07/01/13 Franciscan Healthcare Munster I 1 701 Superior Ave Munster IN 46321-4037 (219) 922-4200 PN 08/01/1350708 OP Surgery 04/01/08 06/30/13 Franciscan Physicians Hospital LLC I 1 701 Superior Ave Munster IN 46321-4037 (219) 922-4200 CP 08/01/13


Change Codes:A: NewC: CancelN: Prov. Name P: Prov. NumberR: ReinstateAC: Accrediation CancelAD: AddressCP: Cancel prov # changePN: Name and Number TE: Telephone NumberTI: Transfer into a classTO: Transfer out of a class 1 Rev. 08-2014

Provider #

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Effective Date



Change Code

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804 OP Surgery 04/01/00 Franciscan St. Margaret Health - Hammond I 1 5454 Hohman Ave. Hammond IN 46320-1931 (219) 932-2300 N 05/01/11801 OP Surgery 04/01/00 Franciscan St. Margaret Mercy Hospital I 1 U.S. Highway 30 Dyer IN 46311 (219) 865-2141 N 05/01/11

77 OP Surgery 01/01/98 Good Samaritan Hospital - Advocate I 1 3815 Highland Avenue Downers Grove IL 60515-1500 (630) 275-5900109 OP Surgery 01/01/98 Good Shepherd Hospital - Advocate I 1 450 West Highway 22 Barrington IL 60010 (847) 381-9600341 OP Surgery 01/01/98 Gottleib Memorial I 1 701 West North Ave. Melrose Park IL 60160-1612 (708) 681-3200352 OP Surgery 04/16/99 Hartgrove Hospital I 1 5730 West Roosevelt Road Chicago IL 60644 (773) 413-1700 AD 05/01/08

21 OP Surgery 01/01/98 Holy Cross Hospital I 1 2701 West 68th Street Chicago IL 60629-1813 (773) 471-800025 OP Surgery 01/01/98 Ingalls Memorial Hospital I 1 One Ingalls Drive Harvey IL 60426-3558 (708) 333-2300

275 OP Surgery 07/01/97 Jersey Community Hospital I 1 400 Maple Summit Road Jerseyville IL 62052-2028 (618) 498-64021 OP Surgery 11/01/97 John H. Stroger Jr Hospital Cook County I 1 1835 W. Harrison Street Chicago IL 60612 (312) 633-6000 N 08/31/05

59 OP Surgery 01/01/98 Kishwaukee Community Hosp. I 1 626 Bethany Road DeKalb IL 60115 (815) 756-1521 A 07/01/98212 OP Surgery 08/01/96 06/30/11 Lawrence County Mem. Hospital I 1 2200 West State Lawrenceville IL 62439 (618) 943-1000 C 10/01/13497 OP Surgery 01/01/96 Linden Oaks Hospital I 1 852 West Street Naperville IL 60540-6400 (630) 305-5500

30 OP Surgery 01/01/98 Little Company of Mary Hospital I 1 2800 West 95th Street Evergreen Park IL 60805-2701 (708) 422-620050073 OP Surgery 01/01/98 Louis A. Weiss Memorial Hospital I 1 4646 North Marine Drive Chicago IL 60640-5700 (708) 216-9000 P 07/09/02

333 OP Surgery 01/01/98 Lutheran General Hospital I 1 1775 Dempster Street Park Ridge IL 60068-1143 (847) 723-2210405 OP Surgery 02/01/00 MacNeal Hospital I 1 3249 S. Oak Park Ave. Berwyn IL 60402-3429 (708) 783-9100 P 05/01/00327 OP Surgery 07/01/97 Memorial Hospital Belleville I 1 4500 Memorial Drive Belleville IL 62226-5399 (618) 233-7750

35 OP Surgery 01/01/98 Mercy Hospital & Med. Ctr. I 1 2525 S. Michigan Ave. Chicago IL 60616 (312) 567-2000880 OP Surgery 04/01/06 Mercy Hospital of Janesville I 1 1000 Mineral Point Avenue Janesville IL 53548-2940 (608) 756-6625 A 12/28/06

85 OP Surgery 01/01/03 Methodist Hospital of Chicago I 1 5025 N. Paulina St. Chicago IL 60640-2772 (773) 271-9040 A 05/01/03116 OP Surgery 01/01/03 Methodist Medical Center (Peoria) I 1 221 NE Glen Oak Ave. Peoria IL 61636-0001 (309) 672-5522 A 03/07/03

50874 OP Surgery 07/30/08 02/29/12 Metrosouth Medical Center I 1 12935 S Gregory St. Blue Island IL 60406 (708) 597-2000 CP 05/01/1251880 OP Surgery 03/01/12 Metrosouth Medical Center I 1 12935 S Gregory St. Blue Island IL 60406 (708) 597-2000 P 05/01/12

38 OP Surgery 01/01/00 Mount Sinai Hospital I 1 California Avenue at 15th Street Chicago IL 60608-1797 (773) 542-2000 TI 12/01/9950135 OP Surgery 01/01/03 05/22/13 Neurological and Orthopedic Institute I 1 4550 North Winchester Ave. Chicago IL 60640-5205 (773) 878-4300 C 12/01/13

15 OP Surgery 01/01/98 NorthShore University Healty System I 1 2650 Ridge Avenue Evanston IL 60201-1718 (847) 570-2000 N 10/01/08


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334 OP Surgery 11/10/08 Northwest Community Hospital I 1 800 W. Centtral Rd. Arlington Hgts IL 60005-2349 (847) 618-1000 TI 11/01/0887 OP Surgery 01/01/98 Northwestern Memorial Hospital I 1 Superior Street at Fairbanks Chicago IL 60611-2914 (312) 908-200039 OP Surgery 01/01/98 Norwegian American I 1 1044 North Francisco Ave. Chicago IL 60622-2743 (773) 278-880052 OP Surgery 01/01/98 Palos Community I 1 12251 South 80th Ave. Palos Hgts IL 60463-1256 (708) 923-4000 TE 11/01/12

230 OP Surgery 01/01/00 Passavant Memorial. Area Hosp. I 1 1600 W. Walnut Jacksonville IL 62650-1136 (217) 245-9551 A 09/01/00200 OP Surgery 05/01/02 Presence Covenant Medical Center I 1 1400 W. Park Street Urbana IL 60506-1449 (217) 337-2000 A 03/07/03340 OP Surgery 01/01/98 Presence Holy Family Medical Center I 1 100 North River Road Des Plaines IL 60016-1209 (847) 813-3100 N 10/01/13

57 OP Surgery 01/01/98 Presence Mercy Medical Center I 1 1325 North Highland Ave. Elgin IL 60123-4912 (815) 725-7133 N 12/01/13316 OP Surgery 01/01/98 Presence Our Lady of the Resurrection I 1 5645 W. Addison Street Chicago IL 60634-4403 (773) 282-7000 N 10/01/13269 OP Surgery 01/01/98 Presence Resurrection Medical Center I 1 7435 West Talcott St. Chicago IL 60631-3702 (773) 774-8000 N 10/01/13

6 OP Surgery 01/01/98 Presence Saint Mary and Elizabeth Medical Center I 1 2233 W. Division Street Chicago IL 60622-3043 (312) 770-2000 PN 10/01/116 OP Surgery 01/01/98 Presence Saint Mary and Elizabeth Medical Center I 1 1431 N. Claremont Ave. Chicago IL 60622-1702 (773) 278-2000 PN 10/01/13

51 OP Surgery 01/01/98 Presence St. Francis Hospital (Evanston) I 1 355 Ridge Avenue Evanston IL 60202-3328 (847) 492-4000 N 10/01/1355 OP Surgery 01/01/98 Presence St. Joseph (Elgin) I 1 77 North Airlite Street Elgin IL 60123-4912 (847) 695-3200 N 10/01/13

415 OP Surgery 06/30/01 Presence St. Joseph Hospital I 1 2900 North Lake Shore Dr. Chicago IL 60657-5640 (773) 665-3000 N 10/01/1356 OP Surgery 01/01/98 Presence St. Joseph Med. Center(Joliet) I 1 333 North Madison St. Joliet IL 60435 (815) 725-7133 N 10/01/1360 OP Surgery 05/01/02 Presence St. Mary's Hospital I 1 500 W. Court S. Chicago IL 60901-3661 (815) 937-2490 N 10/01/13

240 OP Surgery 01/01/98 Presence United Samaritan Medical Center I 1 812 North Logan Danville IL 61832-3716 (217) 443-5000 N 03/07/0393 OP Surgery 11/01/97 Provident Hospital of Cook County I 1 500 East 51st Street Chicago IL 60615 (312) 572-2000 A 07/01/99

305 OP Surgery 06/01/97 R M L Specialty Hospital I 1 5601 South County Line Rd. Hinsdale IL 60521 (630) 268-4223 R 03/07/0350021 OP Surgery 03/01/02 Red Bud Regional Hospital I 1 325 Spring Street Red Bud IL 62278 (618) 282-3831 A 06/01/04

406 OP Surgery 03/01/00 Riveredge Hospital I 1 8311 West Roosevelt Rd. Forest Park IL 60130-2529 (708) 771-7000 PN 05/01/00360 OP Surgery 04/01/98 Riverside Medical Center I 1 350 North Wall Street Kankakee IL 60901 (815) 933-1671 TI 07/01/98

51576 OP Surgery 07/01/10 RML Chicago I 1 3435 W. Van Buren Chicago IL 60624-3312 (630) 286-4000 PN 08/01/1045 OP Surgery 10/12/05 Roseland Community Hospital I 1 45 West 111th Street Chicago IL 60628 (773) 995-3000 R 01/13/0640 OP Surgery 01/01/98 Rush Oak Park Hospital I 1 520 South Maple Ave. Oak Park IL 60304-1022 (708) 383-9300

50462 OP Surgery 10/01/06 Rush-Presbyterian St. Lukes I 1 1653 West Congress Parkway Chicago IL 60612-3809 (312) 942-5000 P 08/15/07


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92 OP Surgery 10/01/97 07/19/13 Sacred Heart Hospital I 1 3240 W. Franklin Blvd. Chicago IL 60624 (773) 772-3020 C 12/01/1351994 OP Surgery 01/01/13 Shriners Hospitals for Children I 1 2211 North Oak Park Ave Chicago IL 60707-3351 (773) 622-5400 A 01/01/13

64 OP Surgery 01/01/98 Silver Cross Hospital I 1 1900 Silver Cross Blvd. New Lenox IL 60451-9509 (815) 300-1100 TE 08/01/1251076 OP Surgery 01/01/09 Skokie Hospital I 1 9600 Gross Point Road Skokie IL 60076-1214 (847) 677-9600 PN 03/01/09

259 OP Surgery 01/01/98 South Suburban Hospital - Advocate I 1 17800 S. Kedzie Ave. Hazel Crest IL 60429-2029 (708) 799-8000170 OP Surgery 05/01/13 St Marys Hospital I 1 1800 E. Lake Shore Drive Decatur IL 62521-3810 (217) 464-2966 A 06/01/13398 OP Surgery 02/01/99 St. Alexius Med. Center I 1 1555 N. Barrington Rd. Hoffman Estates IL 60194-1018 (847) 843-2000 A 04/01/00210 OP Surgery 01/01/98 St. Anthony (Chicago) I 1 2875 W. 19th Street Chicago IL 60623-3501 (773) 521-1710371 OP Surgery 04/01/13 St. Anthony Med. Center I 1 5666 East State Street Rockford IL 61108-2425 (815) 226-2000 R 05/01/13838 OP Surgery 03/01/99 St. Anthony Medical Center of Crown Point I 1 1201 S. Main Street Crown Point IN 46307 (219) 663-8120 N 07/01/99

47 OP Surgery 01/01/98 St. Bernard Hospital I 1 326 West 64th Street Chicago IL 60621-3119 (773) 962-3900248 OP Surgery 01/01/96 St. Elizabeth's Hospital I 1 211 S. Third Street Belleville IL 62222 (618) 234-2120

50 OP Surgery 01/01/98 St. Francis Hospital (Blue Island) I 1 12935 S. Gregory Blue Island IL 60406-2428 (708) 597-2000 PN 09/01/08404 OP Surgery 01/08/00 06/30/11 St. James Hosp.& Health Ctrs-Olympia Fields I 1 20201 S. Crawford Olympia Field IL 60461-0100 (708) 747-4000 CP 08/01/11

53 OP Surgery 01/01/98 St. James Hospital I 1 1423 Chicago Road Chicago Hgts IL 60411-3400 (708) 756-1000174 OP Surgery 05/01/98 St. John's Hospital I 1 800 East Carpenter St. Springfield IL 62769 (217) 544-6464 A 07/01/98204 OP Surgery 08/05/01 St. Joseph Memorial Hosp. I 1 Two South Hospital Drive Murphysboro IL 62966-3337 (618) 684-3156 P 02/27/02181 OP Surgery 10/01/97 St. Joseph’s Hospital I 1 9515 Holy Cross Lane Breese IL 62230-0099 (618) 526-4511251 OP Surgery 07/01/97 St. Joseph's Hospital I 1 12866 Troxler Ave. Highland IL 62249-1698 (618) 654-7421 AD 10/01/13

50862 OP Surgery 07/01/08 04/21/11 Surgical Hospital of Munster I 1 7847 Calumet Ave Munster IN 46321-1213 (219) 836-5102 C 10/01/1367 OP Surgery 01/01/98 Swedish Covenant I 1 5145 N. California Ave. Chicago IL 60625-3642 (773) 878-8200

173 OP Surgery 01/01/97 Taylorville Memorial Hospital I 1 201 E. Pleasant Street Taylorville IL 62568 (217) 824-3331 N 10/16/0780 OP Surgery 01/01/98 The Ann and Robert H. Lurie Children's Hospital I 1 225 E Chicago Ave. Chicago IL 60611-2605 (312) 227-4000 N 08/01/12

829 OP Surgery 01/01/05 The Community Hospital I 1 901 MacArthur Blvd. Munster IN 46321-2901 (219) 836-1600 TI 01/10/052 OP Surgery 01/01/98 Thorek Memorial Hospital I 1 850 West Irving Park Rd. Chicago IL 60613-3011 (773) 525-6780

65 OP Surgery 01/01/98 Trinity Hospital - Advocate I 1 2320 East 93rd Street Chicago IL 60617-3909 (773) 978-2000401 OP Surgery 09/01/08 University of Chgo. Med. Center I 1 5841 Maryland Ave. Chicago IL 60637-1463 (773) 702-1000 TI 09/01/08


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112 OP Surgery 04/01/13 University of Illinois I 1 1740 West Taylor Street Chicago IL 60612-7232 (312) 996-3892 TI 03/01/13394 OP Surgery 01/01/99 Valley West Community Hospital I 1 11 E. Pleasant Sandwich IL 60548 (815) 786-8484 R 02/01/00

50055 OP Surgery 11/01/06 VanMatre Health South Rehabiliation Hosp I 1 950 S. Mulford Road Rockford IL 61108-4274 (815) 381-8500 A 03/10/0851587 OP Surgery 08/01/10 VHS West Suburban Medical Center I 1 3 Erie Court Oak Park IL 60302-2510 (708) 383-6200 PN 08/01/1051588 OP Surgery 08/01/10 VHS Westlake Hospital Inc I 1 1225 West Lake Street Melrose Park IL 60160-4021 (847) 681-3000 PN 08/01/1050448 OP Surgery 07/01/06 Vista Medical Center East I 1 1324 North Sheridan Rd. Waukegan IL 60085-2161 (847) 360-3000 PN 12/28/0650449 OP Surgery 07/01/06 Vista Medical Center West I 1 2615 Washington Street Waukegan IL 60085-4916 (847) 249-3900 PN 12/28/06

73 OP Surgery 06/01/02 West Suburban Hospital I 1 3 Erie Court Oak Park IL 60302-2510 (708) 383-620074 OP Surgery 01/01/98 Westlake Community Hospital I 1 1225 West Lake Street Melrose Park IL 60160-4021 (847) 681-3000

233 OP Surgery 02/01/09 Alton Memorial II 2 One Momorial Drive Alton IL 62002-6722 (618) 463-7390 TI 02/05/0950033 OP Surgery 02/01/09 Aurora Chicago Lakeshore Hospital II 2 4840 North Marine Drive Chicago IL 60640-4220 (773) 878-9700 TI 02/05/09

131 OP Surgery 02/01/09 Crossroads - Mt. Vernon II 2 #8 Doctor's Park Mount Vernon IL 62864-6224 (618) 244-5500 TI 02/05/09810 OP Surgery 02/01/09 Deaconess Hospital (IN) II 2 600 Mary Street Evansville IL 62864-6224 (618) 244-5500 TI 02/05/09

50078 OP Surgery 02/01/09 Franklin Hospital II 2 201 Bailey Lane Benton IL 62812-1969 (618) 439-3161 TI 02/05/0914 OP Surgery 02/01/09 Good Samaritan - Mt. Vernon II 2 1 Good Samaritan Way Mount Vernon IL 62864-2857 (618) 242-4600 AD 10/01/13

298 OP Surgery 02/01/09 Heartland Regional Medical Center II 2 917 West Main Street Marlon IL 62959-1836 (618) 997-5341 TI 02/05/09140 OP Surgery 02/01/09 Herrin Hospital II 2 201 S. 14th Street Herrin IL 62948-2857 (618) 942-2171 TI 02/05/09

26 OP Surgery 02/01/09 Jackson Park Hospital II 2 7531 Stony Island Avenue Chicago IL 60649-3913 (773) 947-7500 TI 02/05/09195 OP Surgery 02/01/09 Kindred Chicago Central Hospital II 2 4058 W. Melrose Street Chicago IL 60641 (773) 736-7000 TI 02/05/09106 OP Surgery 02/01/09 Kindred Hospital Chicago Northlake II 2 365 East North Avenue Northlake IL 60164 (708) 345-8100 TI 02/05/09

28 OP Surgery 02/01/09 Kindred Hospital Sycamore II 2 225 Edward Street Sycamore IL 60178 (815) 895-2144 TI 02/05/09160 OP Surgery 02/01/09 LaRabida Children's Hospital II 2 6501 Promontory Drive Chicago IL 60649-1326 (773) 363-6700 TI 02/05/09

31 OP Surgery 02/01/09 Loretto Hospital II 2 645 South Centeral Chicago IL 600644-5059 (773) 626-4300 TI 02/05/09500 OP Surgery 01/01/98 Loyola University Med. Ctr. II 2 2160 South First Ave. Maywood IL 60153-3304 (708) 216-9000

7 OP Surgery 02/01/09 Marianjoy Rehab. Hospital II 2 26 West 171 Roosevelt Rd. Wheaton IL 60187-0795 (630) 909-8000 TE 09/01/12237 OP Surgery 02/01/09 Memorial Hospital (Carbondale) II 2 405 West Jackson Street Carbondale IL 62901-2904 (618) 549-0721 TI 02/05/09347 OP Surgery 02/01/09 Memorial Hospital (Chester) II 2 1900 State Street Chester IL 62233-1116 (618) 826-4581 TI 02/05/09


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175 OP Surgery 02/01/09 Memorial Medical Center II 2 701 N. 1st Street Springfield IL 62702-3757 (217) 788-3000 TI 02/05/09196 OP Surgery 01/01/98 Mercy Harvard Hospital (WI) II 2 901 Grant Street Harvard IL 62959-1836 (618) 997-5341 N 02/01/08802 OP Surgery 02/01/09 Methodist (Northlake IN) II 2 600 Grant Street Gary IN 46402-6000 (219) 886-4000 TI 02/05/09828 OP Surgery 02/01/09 Methodist (Southlake IN) II 2 8701 Broadway Merrillville IN 46410-7035 (219) 886-4000 TI 02/05/09117 OP Surgery 02/01/09 Proctor Community II 2 5409 North Knoxville Ave. Peoria IL 61614-5016 (309) 691-4702 TI 02/05/09354 OP Surgery 02/01/09 Rehab. Inst. of Chicago II 2 345 East Superior St. Chicago IL 60611-3015 (312) 908-6000 TI 02/05/09353 OP Surgery 02/01/09 Schwab Rehabilitation Hospital II 2 1401 S. California Ave. Chicago IL 60608-1612 (773) 522-2010 TI 02/05/09

66 OP Surgery 02/01/09 South Shore Hospital II 2 8012 S. Crandon Chicago IL 60617-1151 (773) 768-0810 TI 02/05/09859 OP Surgery 02/01/09 SSM Rehabilitation Institute II 2 6420 Clayton Road St. Louis MO 63117-1811 (314) 768-5200 TI 02/05/09806 OP Surgery 01/01/98 St. Catherine Hospital (IN) II 2 4321 Fir Street East Chicago IN 46312-3049 (219) 392-1700867 OP Surgery 02/01/09 St. Louis Children's II 2 One Children's Place St. Louis MO 63110-1077 (314) 454-6000 TI 02/05/09803 OP Surgery 01/01/98 St. Mary's (Gary and Hobart, IN) II 2 1500 South Lake Park Hobart IN 46342 (219) 942-0551870 OP Surgery 02/01/09 St. Mary's Health Center II 2 6420 Clayton Road St. Louis MO 63117 (314) 768-8000 TI 02/05/09370 OP Surgery 02/01/09 Swedish American II 2 1400 Charles Street Rockford IL 61104-2224 (815) 968-4400 TI 02/05/09112 OP Surgery 03/01/02 03/31/13 University of Illinois II 2 1740 West Taylor Street Chicago IL 60612-7232 (312) 996-3892 TO 03/01/13

59999 OP Surgery 03/01/12 Des Peres Hospital III 3 2345 Dougherty Ferry Road St Louis MO 63122-3313 (314) 966-9100 A 09/01/1259998 OP Surgery 03/01/12 St. Louis University Hospital III 3 3635 Vista St Louis MO 61110-2539 (314) 577-8000 A 09/01/12



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51649 Renal Dialysis 10/01/10 Adams County Dialysis I 0 436 N. 10th Street Quincy IL 62301 (217) 223-7913 A 01/01/1163 Renal Dialysis 01/01/05 Advocate Sherman Hospital I 0 1425 N Randall Road Elign IL 60120 (847) 742-9800 AD 12/01/09

50490 Renal Dialysis 09/01/06 Affiliated Dialysis I 0 715 Lake Street Oak Park IL 60301 (630) 690-464252128 Renal Dialysis 07/01/13 Affiliated Dialysis Of Glen Ellyn I 0 800 Roosevelt Glen Ellyn IL 60137 (309) 698-1800 A 11/01/1351041 Renal Dialysis 01/01/09 Affiliated Home Dialysis I 0 2500 N. Main Street East Peoria IL 61611 (309) 698-1800 A 04/01/1050357 Renal Dialysis 01/01/05 Aledo Kidney Center, LLC I 0 409 N.W. Ninth Avenue Aledo IL 61231 (309) 762-557050592 Renal Dialysis 01/01/05 Alton Dialysis I 0 3511 College Street Alton IL 62002 (618) 465-4745

664 Renal Dialysis 01/01/05 Aurora Dialysis Center I 0 455 Mercy Lane Aurora IL 60506 (630) 892-744550355 Renal Dialysis 01/01/05 Austin Community Kidney Center I 0 4800 W. Chicago Avenue Chicago IL 60651 (773) 287-068051989 Renal Dialysis 11/01/12 Barrington Creek Dialysis I 0 28160 W. Northwest Hwy Lake Barrington IL 60010 (847) 381-1325 A 12/01/1250565 Renal Dialysis 01/01/05 Benton Dialysis I 0 1151 Route 14 West Benton IL 62812 (618) 435-485050560 Renal Dialysis 01/01/05 Beverly Dialysis I 0 8109 South Western Avenue Chicago IL 60620 (773) 238-5200 AD 02/11/1051687 Renal Dialysis 02/01/11 Big Oaks Dialysis I 0 5623 W. Touhy Avenue Niles IL 60714 (847) 647-3140 A 04/01/11

2139 Renal Dialysis 01/01/05 08/31/13 Bma Belmont I 0 4943 West Belmont Avenue Chicago IL 60641 (773) 685-7500 CP 12/01/13660 Renal Dialysis 01/01/05 Bma Of Carbondale I 0 725 S. Lewis Lane Carbondale IL 62901 (618) 529-2112659 Renal Dialysis 01/01/05 Bma Of Niles I 0 7332 Milwaukee Avenue Niles IL 60714 (847) 647-8505

2137 Renal Dialysis 01/01/05 Bolingbrook Dialysis Center I 0 329 Remington Blvd Boilingbrook IL 60440 (630) 972-8662 AD 09/01/1350400 Renal Dialysis 01/01/05 Center For Renal Replacement LLC I 0 7301 N. Lincoln Lincolnwood IL 60712 (847) 675-555550567 Renal Dialysis 01/01/05 Centralia Dialysis I 0 1231 State Route 161 East Centralia IL 62801 (618) 533-2535 AD 04/01/1450206 Renal Dialysis 01/01/05 Chicago Heights Dialysis I 0 177 B West Joe Orr Road Chicgo Heights IL 60411 (708) 755-9000 A 07/01/09

652 Renal Dialysis 01/01/05 Chicagoland Dialysis Center I 0 820 W. Jackson Blvd Chicago IL 60607 (312) 930-936550268 Renal Dialysis 01/01/05 Churchview Dialysis I 0 5970 Churchview Drive Rockford IL 61107 (815) 971-8252

687 Renal Dialysis 01/01/05 Circle Medical Management I 0 1426 W. Washington Blvd Chicago IL 60607 (312) 829-142451707 Renal Dialysis 03/01/11 Cobblestone Dialysis I 0 836 Dundee Avenue Elgin IL 60120 (847) 888-9386 AD 08/01/1251214 Renal Dialysis 01/01/09 Community Dialysis Of Harvey I 0 16641 S Halsted Street Harvey IL 60426 6100 (708) 210-9500 A 04/01/1050586 Renal Dialysis 01/01/05 Comprehensive Renal Care - East Chicago I 0 4320 Fir Street East Chicago IN 46312 (219) 397-119950588 Renal Dialysis 01/01/05 Comprehensive Renal Care - Gary I 0 4802 Broadway Gary IN 46408 (219) 887-119950589 Renal Dialysis 01/01/05 Comprehensive Renal Care - Hammond I 0 222 Douglas St Hammond IN 46320 (219) 932-119950602 Renal Dialysis 01/01/05 Comprehensive Renal Care Michigan City I 0 120 Dunes Plaza Michigan City IN 46360 (219) 878-198950603 Renal Dialysis 01/01/05 Comprehensive Renal Care Valparaiso I 0 606 E. Lincolnway Valparaiso IN 46383 (219) 531-1299



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50591 Renal Dialysis 01/01/05 CRC - Munster I 0 8317 Calumet Avenue Munster IN 46321 (219) 836-1299 N 10/15/1152101 Renal Dialysis 05/01/13 Crimson Ridge Home Training I 0 2540 Hauser Ross Drive Sycamore IL 60178 (815) 748-3508 A 10/01/1352101 Renal Dialysis 05/01/13 Crimson Ridge Home Training I 0 2540 Hauser Ross Drive Sycamore IL 60178-3171 (815) 748-3508 A 11/01/1351453 Renal Dialysis 11/01/09 Crystal Lake Dialysis Llc I 0 6298 Northwest Hwy Crystal Lake IL 60014 (815) 477-8025 A 02/01/1051986 Renal Dialysis 09/01/12 Crystal Springs Dialysis I 0 720 Cog Circle Crystal Lake IL 60014-7301 (815) 459-4945 A 12/01/1251708 Renal Dialysis 03/01/11 08/31/12 Crystal Springs Dialysis I 0 4900 South IL Rt 31 Crystal Lake IL 60012 (224) 783-5815 C 03/01/1351819 Renal Dialysis 10/01/11 Danville Dialysis Services I 0 910 W. Clay Street Danville Illinois 61832 (217) 446-1111 A 12/01/1151990 Renal Dialysis 11/01/12 Danville Home Training I 0 3 Poland Road Danville IL 61834 (217) 443-3350 A 12/01/1257836 Renal Dialysis 09/01/13 Davita A/k/a Shiloh Dialysis I 0 1095 N. Green Mount Road Belleville IL 62221 (618) 628-1108 A 04/01/1450247 Renal Dialysis 01/01/05 Davita Granite City I 0 9 American Village Shopping Ctr Granite City IL 62040 (618) 452-5858 P50568 Renal Dialysis 01/01/05 Decatur Eastwood Dialysis I 0 794 East Wood Street Decatur IL 62573 (217) 425-6403

632 Renal Dialysis 01/01/05 Dialysis Center Of America I 0 4861-73 Cal Sag Rd Crestwood IL 60445 (708) 385-1400640 Renal Dialysis 01/01/05 Dialysis Center Of America D/b/a Rcg Garfield I 0 5401 S. Wentworth Chicago IL 60609 (773) 548-5714635 Renal Dialysis 01/01/05 Dialysis Center Of America D/b/a Rcg Orland Pk I 0 9160 W. 159th St Orland Park IL 60462 (708) 403-2790634 Renal Dialysis 01/01/05 Dialysis Center Of America D/b/a Rcg Prairie I 0 1712 S. Prairie Chicago IL 60616 (312) 913-0000637 Renal Dialysis 01/01/05 Dialysis Center Of America D/b/a Rcg Rogers Pk I 0 2277 W. Howard St Chicago IL 60645 (773) 262-7147

51850 Renal Dialysis 11/01/11 Dialysis Newco I 0 4651 West 79th Street Chicago IL 60652 (773) 582-8911 A 03/01/1250352 Renal Dialysis 01/01/05 Direct Dialysis I 0 14255 S. Cicero Avenue Crestwood IL 60445 (708) 824-920050306 Renal Dialysis 01/01/05 Dixon Dialysis Center, LLC I 0 101 W. 2nd Street Dixon IL 61021 (309) 762-557050338 Renal Dialysis 01/01/05 Dixon Kidney Center I 0 1131 N. Galena Avenue Dixon IL 61021 (815) 284-0595

650 Renal Dialysis 01/01/05 Downers Grove Dialysis Center I 0 3825 Highland Ave Downers Grove IL 60515 (630) 964-260552065 Renal Dialysis 03/01/13 Driftwood I 0 1808 S. West Avenue Freeport IL 61032 (818) 232-0295 A 07/01/1350624 Renal Dialysis 01/01/05 DSI Buffalo Grove I 0 1291 W. Dundee Road Buffalo Grove IL 60089 (247) 253-5400 PN 11/01/0850631 Renal Dialysis 08/01/07 DSI Renal Arlington Heights I 0 17 W Golf Road Arlington Heights il 60006 (847) 437-2188 A 11/01/0850626 Renal Dialysis 01/01/05 DSI Renal Markham I 0 3053 3065 W. 159th Street Markham IL 60426 (708) 333-3516 PN 11/01/0850622 Renal Dialysis 01/01/05 DSI Renal Schaumburg I 0 1156 S. Roselle Road SCHAUMBURG IL 60193 (847) 524-4310 PN 11/01/0850629 Renal Dialysis 01/01/05 DSI Renal Waukegan I 0 1616 Grand Avenue C Waukegan IL 60085 (847) 662-5111 PN 11/01/0851583 Renal Dialysis 08/01/10 DSI Schaumburg Home Renal Center I 0 17 W. Golf Road Arlington Heights IL 60005 (847) 437-2188 A 08/01/1050628 Renal Dialysis 01/01/05 10/31/11 DSL Scottsdale I 0 7929 S. Cicero Avenue Chicago IL 60652 (773) 582-8911 C 10/01/1351583 Renal Dialysis 08/01/10 DSI Waukegan Home Renal Center I 0 1616 Grand Avenue Waukegan IL 60085 (874) 360-9621 A 08/01/10


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2151 Renal Dialysis 01/01/05 Dupage Peritoneal Dialysis Service I 0 183 N. Addison Elmhurst IL 60126 (630) 858-802552003 Renal Dialysis 12/01/12 East Chicago Dialysis Center I 0 1207 E. Chicago Avenue East Chicago IN 46312 (219) 397-7751 P 02/01/13

2107 Renal Dialysis 01/01/05 11/30/12 East Chicago Dialysis Center I 0 1207-19 Chicago Avenue East Chicago IN 46312 (219) 397-7751 CP 02/01/1351647 Renal Dialysis 10/01/10 Edwardsville Dialysis I 0 235 S. Buchanan Street Edwardsville IL 62025 (618) 692-9217 A 01/01/1150569 Renal Dialysis 01/01/05 Effingham Dialysis I 0 904 Medical Park Drive Effingham IL 62401 (217) 342-9558

654 Renal Dialysis 01/01/05 Elk Grove Dialysis Ctr I 0 901 Biesterfield Rd Elk Grove Village IL 60007 (847) 737-08242112 Renal Dialysis 01/01/05 Elk Grove Home Dialysis Center I 0 901 Biesterfield Rd Elk Grove IL 60007 (847) 952-9890

50060 Renal Dialysis 01/01/05 Emerald Kindney Center I 0 710 West 43rd Street Chicago IL 60609 (773) 947-077050630 Renal Dialysis 01/01/05 Evanston Renal Center I 0 1922 Dempster Street Evanston IL 60202 (847) 869-5336 AD 01/01/1450328 Renal Dialysis 01/01/05 FMC – Ottawa I 0 1000 E. Norris Drive Ottawa IL 61350 (815) 434-2125

648 Renal Dialysis 01/01/05 FMC Blue Island I 0 12200 S. Western Blue Island IL 60406 (708) 597-993350658 Renal Dialysis 01/01/05 FMC Chicago West Side Dialysis I 0 1340 S. Damen Chicago IL 60608 (312) 738-258750200 Renal Dialysis 01/01/05 FMC Dialysis Service Of Alsip I 0 12250 S. Cicero Avenue Alsip IL 60803 (708) 389-095550201 Renal Dialysis 01/01/05 FMC Dialysis Service Of Congress Parkway I 0 3410 W. Vanburen Street Chicago IL 60624 (773) 722-4245

669 Renal Dialysis 01/01/05 FMC Dialysis Service Of Westchester I 0 2400 Wolf Road Westlake IL 60154 (708) 409-778050202 Renal Dialysis 01/01/05 FMC Dialysis Service Of Willowbrook I 0 6300 Kingery Highway Willowbrook IL 60527 (630) 325-030950733 Renal Dialysis 01/01/05 FMC Dupage Home Dialysis I 0 242 N. York Road Elmhurst IL 60126 (630) 832-5276

2109 Renal Dialysis 01/01/05FMC Lagrange Home Dialysis Center Service Of Westchester I 0 2400 Wolf Rd Westchester IL 60154 (708) 562-8220

50423 Renal Dialysis 01/01/05 FMC Lake Bluff I 0 101 Wakegan Road Lake Bluff IL 60044 (847) 735-087051528 Renal Dialysis 02/01/10 FMC Lombard Home Therapies I 0 1960 Springer Drive Lombard IL 60148 (630) 693-0394 A 04/01/1050436 Renal Dialysis 01/01/05 FMC Mchenry I 0 4312 W. Elm Street McHenry IL 60050 (815) 363-725450125 Renal Dialysis 01/01/05 FMC Of Williamson City I 0 900 Skyline Drive, #200 Marion IL 62959 (618) 993-162550300 Renal Dialysis 01/01/05 08/31/13 FMCNA Burbank I 0 4811 W. 77th Street Burbank IL 60459 (708) 229-0584 CP 12/01/13

644 Renal Dialysis 01/01/05 Fox Valley Dialysis I 0 1300 Waterford Dr Aurora IL 60504 (630) 851-481250265 Renal Dialysis 01/01/05 Freeport Dialysis I 0 1028 Konkle Blvd. Freeport IL 61032 (815) 232-2477

655 Renal Dialysis 01/01/05 Fresenius Dupage West Dialysis I 0 450 E. Roosevelt West Chicago IL 60185 (630) 293-6356 N 06/01/1152108 Renal Dialysis 08/01/13 Fresenius Med Care Naperbrook I 0 2451 S Washington St Naperville IL 60565 (630) 428-9769 A 10/01/1351593 Renal Dialysis 03/01/10 08/30/13 Fresenius Medial Care Midway I 0 6201 W. 63rd Street Chicago IL 60674 (773) 229-8268 CP 01/01/1455809 Renal Dialysis 09/01/13 Fresenius Medial Care Midway I 0 6201 W. 63rd Street Chicago IL 60674 (773) 229-8268 P 01/01/14


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51613 Renal Dialysis 09/01/10 Fresenius Medical Care Lombard I 0 1940 Springer Drive Lombard IL 60148 (630) 693-0394 A 10/01/1051129 Renal Dialysis 01/01/09 Fresenius Medical Caqe - Streator I 0 2356 N BLOOMINGTON STREATOR IL 61364 (815) 673-2200 A 05/01/0950334 Renal Dialysis 01/01/05 Fresenius Medical Care – Kewanee I 0 230 W. South Street Kewanee IL 61443 (309) 854-0917

699 Renal Dialysis 01/01/05 08/30/13 Fresenius Medical Care - Niles I 0 9371 Milwaukee Avenue Niles IL 60714 (847) 518-8100 CP 01/01/1456103 Renal Dialysis 09/01/13 Fresenius Medical Care - Niles I 0 9371 Milwaukee Avenue Niles IL 60714 (847) 518-8100 P 01/01/1451353 Renal Dialysis 07/01/09 Fresenius Medical Care - West Chicago I 0 1850-63 Neltor Boulevard West Chicago IL 60185 (630) 293-5952 A 07/01/0955029 Renal Dialysis 09/01/13 Fresenius Medical Care Bridgeport I 0 825 W. 35th Street Chicago IL 60609 (773) 890-4330 P 12/01/1357780 Renal Dialysis 09/01/13 Fresenius Medical Care Burbank I 0 4811 W. 77th Street Burbank IL 60459 (708) 229-0584 P 12/01/1351924 Renal Dialysis 06/01/12 Fresenius Medical Care Chatham I 0 8710 S. Holland Road Chicago IL 60620 (773) 723-2536 A 10/01/1252038 Renal Dialysis 03/01/13 Fresenius Medical Care Cicero I 0 3000 S. Cicero Avenue Cicero IL 60677 (708) 652-7089 A 05/01/13

2106 Renal Dialysis 01/01/05 11/30/12 Fresenius Medical Care Crown Point I 0 851 Burrells Street Crown Point IN 46307-8898 (219) 663-9955 CP 02/01/1352006 Renal Dialysis 12/01/12 Fresenius Medical Care Crown Point I 0 851 Burrell Street Crown Point IN 46307 (219) 662-2648 P 02/01/1351586 Renal Dialysis 03/01/10 Fresenius Medical Care Deerfield I 0 405 Lake Cook Road Deerfield IL 60015 (847) 559-1374 A 09/01/1053400 Renal Dialysis 05/01/14 Fresenius Medical Care Desplaines I 0 1625 Oakton Place DesPlaines IL 60018 (773) 248-3105 A 08/01/14

2142 Renal Dialysis 01/01/05 Fresenius Medical Care Duquoin I 0 4 W. Main Street DuQuoin IL 62832 (618) 542-647752008 Renal Dialysis 12/01/12 Fresenius Medical Care Dyer I 0 2150 Gettler Street Dyer IN 46311 (219) 322-3710 P 02/01/1351217 Renal Dialysis 09/01/12 11/30/12 Fresenius Medical Care Dyer In I 0 2150 Gettler Street Dyer IN 46311-3710 (219) 322-3710 CP 02/01/1351614 Renal Dialysis 09/01/10 Fresenius Medical Care Elgin I 0 2130 Point Blvd Elgin IL 60125 (847) 425-3605 A 10/01/1056687 Renal Dialysis 09/01/13 Fresenius Medical Care Evergreen Park I 0 9730 S. Western Avenue Evergreen Park IL 60805 (708) 423-8833 P 12/01/1352048 Renal Dialysis 03/01/13 Fresenius Medical Care Galesburg I 0 765 N. Kellogg Street Galesburg IL 61401 (309) 945-4580 A 05/01/1352005 Renal Dialysis 12/01/12 Fresenius Medical Care Gary I 0 3290 Grant Street Gary IN 46408 (219) 980-2860 PN 02/01/13

2146 Renal Dialysis 01/01/05 Fresenius Medical Care Harrisburg I 0 275 Small Street Harrisburg IL 62946 (618) 252-110956223 Renal Dialysis 01/01/05 Fresenius Medical Care Hazel Crest I 0 17524 Carriageway Hazel Crest IL 60429 (708) 798-2899 P 02/01/1451148 Renal Dialysis 03/01/09 11/30/12 Fresenius Medical Care Hobart I 0 1310 W. Wisconsin Street Hobart IN 46342 (219) 947-9289 CP 02/01/1352002 Renal Dialysis 12/01/12 Fresenius Medical Care Hobart I 0 1310 W. Wisconsin Street Hobart IN 46342 (219) 947-9289 P 02/01/1353071 Renal Dialysis 09/01/13 Fresenius Medical Care Hoffman Estates I 0 3150 W. Higgins Road Hoffman Estates IL 60195 (847) 310-0074 P 12/01/1351923 Renal Dialysis 05/01/12 Fresenius Medical Care Joliet I 0 721 E. Jackson Street Joliet IL 60432 (815) 726-8619 A 10/01/1252093 Renal Dialysis 06/01/13 Fresenius Medical Care Logan Square I 0 2721 N. Spaulding Chicago IL 60647 (773) 292-2971 A 09/01/1352126 Renal Dialysis 07/01/13 Fresenius Medical Care Macomb I 0 523 E. Grant Street Macomb IL 61455 (309) 836-1662 A 11/01/1359283 Renal Dialysis 09/01/13 Fresenius Medical Care Marquette Park I 0 6535 S. Western Avenue P 12/01/13


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55447 Renal Dialysis 09/01/13 Fresenius Medical Care Melrose Park I 0 1111 Superior Street Melrose Park IL 60160 (708) 338-1780 P 12/01/1351438 Renal Dialysis 10/01/09 06/30/11 Fresenius Medical Care Metropolis I 0 20 Hospital Drive Metropolis IL 62960 (618) 524-3046 CP 12/01/1151830 Renal Dialysis 11/01/11 Fresenius Medical Care Mundelein I 0 1402 Townline Road Mundelein Illinois 60060 (847) 949-3904 A 01/01/1252953 Renal Dialysis 09/01/13 Fresenius Medical Care Munster I 0 314 Ridge Road Munster IN 46321 (219) 836-9317 P 12/01/1352108 Renal Dialysis 08/01/13 Fresenius Medical Care Naperbrook I 0 2451S. Washington Street Naperville IL 60565 (630) 428-9769 A 11/01/1353686 Renal Dialysis 09/01/13 Fresenius Medical Care Norridge I 0 4701 Cumberland Avenue Norridge IL 60706 (708) 456-0152 P 12/01/13

680 Renal Dialysis 01/01/05 08/31/13 Fresenius Medical Care North Center I 0 2620 W. Addison Street Chicago IL 60618 (773) 248-0462 CP 12/01/1357392 Renal Dialysis 09/01/13 Fresenius Medical Care North Kilpatrick I 0 4800 N. Kilpatrick Chicago IL 60630 (773) 545-3693 P 12/01/1354562 Renal Dialysis 09/01/13 Fresenius Medical Care Northcenter I 0 2620 W. Addison Street Chicago IL 60618 (773) 248-0462 P 12/01/1352127 Renal Dialysis 09/01/13 Fresenius Medical Care Oak Forest I 0 5340A W. 159th Street Oak Forest IL 60452 (708) 535-0080 A 12/01/1352044 Renal Dialysis 12/01/12 Fresenius Medical Care Oak Park I 0 733 Madison Street Oak Park IL 60302 (708) 386-8757 PN 05/01/1350489 Renal Dialysis 01/01/05 Fresenius Medical Care Of Antioch I 0 311 Depot Antioch IL 60002 (847) 395-585450637 Renal Dialysis 01/01/05 08/30/13 Fresenius Medical Care Of Lakeview I 0 4008 N. Broadway Chicago IL 60613 (773) 248-3105 CP 01/01/1454071 Renal Dialysis 09/01/13 Fresenius Medical Care Of Lakeview I 0 4008 N. Broadway Chicago IL 60613 (773) 248-3105 P 01/01/1450993 Renal Dialysis 06/01/08 Fresenius Medical Care Of Mokena I 0 8910 W. 192nd Street Mokena IL 60448 (708) 478-1815 A 04/01/0850635 Renal Dialysis 01/01/05 Fresenius Medical Care Of Naperville I 0 516 w. 5Tth Street Naperville IL 60563 (630) 753-929550634 Renal Dialysis 01/01/05 Fresenius Medical Care Of Oswego I 0 1051 Station Drive Oswego IL 60543 (630) 554-478351733 Renal Dialysis 04/01/11 Fresenius Medical Care Palatine I 0 691 E. Dundee Road Palatine IL 60074 (847) 963-4299 A 06/01/1151527 Renal Dialysis 01/01/10 Fresenius Medical Care Plainfield I 0 2320 Michas Drive Plainfield IL 60586 (815) 230-2267 A 04/01/1058016 Renal Dialysis 09/01/13 Fresenius Medical Care Polk Street I 0 557 W. Polk Street Chicago IL 60607 (312) 834-0653 P 12/01/13

2143 Renal Dialysis 01/01/05 Fresenius Medical Care Randolph I 0 102 Memorial Drive Chester IL 62233 (618) 826-444155723 Renal Dialysis 09/01/13 Fresenius Medical Care Reoseland I 0 132 W. 111th Street Chicago IL 60628 (773) 995-1738 P 12/01/1351813 Renal Dialysis 11/01/11 Fresenius Medical Care River Forest I 0 103 Forest Avenue River Forest IL 60305 (708) 488-9258 A 11/01/1154507 Renal Dialysis 09/01/13 Fresenius Medical Care Rolling Meadows I 0 4180 Winnetka Avenue Rolling Meadows IL 60008 (847) 394-6250 P 12/01/1351071 Renal Dialysis 11/01/08 08/31/13 Fresenius Medical Care Roseland I 0 132 W. 111th Street Chicago IL 60628-4515 (773) 995-1783 CP 12/01/1351216 Renal Dialysis 04/01/09 Fresenius Medical Care Sandwich I 0 1310 N. Main Street Sandwich IL 60548 (815) 786-8470 A 04/01/1154648 Renal Dialysis 09/01/13 Fresenius Medical Care South Chicago I 0 9200 S. Chicago Ave Chicago IL 60617 (773) 734-7433 P 12/01/1352039 Renal Dialysis 03/01/13 Fresenius Medical Care South Deering I 0 10559 S. Torrence Avenue Chicago IL 60617 (773) 768-7100 A 05/01/1357820 Renal Dialysis 09/01/13 Fresenius Medical Care South Holland I 0 17225 S. Paxton Avenue South Holland IL 60473 (708) 474-8700 P 12/01/1353894 Renal Dialysis 09/01/13 Fresenius Medical Care South Shore I 0 2420 E. 79th Street Chicago IL 60649 (773) 374-9002 P 12/01/13


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2145 Renal Dialysis 01/01/05 Fresenius Medical Care Southwestern I 0 7 Eastgate Plaza, Rt. 3&4 East Alton IL 62024 (618) 254-111751128 Renal Dialysis 01/01/09 Fresenius Medical Care Uptown I 0 4720 N MARINE DRIVE CHICAGO IL 60674 (773) 989-8082 A 05/01/0951800 Renal Dialysis 09/01/11 Fresenius Medical Care Waukegan Harbor I 0 110 N. West Street Waukegan IL 60085 (847) 599-1346 A 11/01/1151797 Renal Dialysis 08/01/11 Fresenius Medical Care West Batavia I 0 2580 West Fabyan Parkway Batavia IL 60510 (630) 406-1690 A 11/01/1155315 Renal Dialysis 09/01/13 Fresenius Medical Care West Belmont I 0 4943 West Belmont Avenue Chicago IL 60641 (773) 685-7500 P 12/01/1351799 Renal Dialysis 08/01/11 Fresenius Medical Care West Willow I 0 1444 W. Willow Street Chicago IL 60642 (773) 248-3105 A 11/01/11

656 Renal Dialysis 01/01/05 08/31/13 Fresenius Medical Center Of Polk Street I 0 557 W. Polk Street Chicago IL 60611 (312) 834-0653 CP 12/01/1350229 Renal Dialysis 01/01/05 07/01/11 Gambro Healthcare – Breese I 0 160 N. Main Street Breese IL 62230 (618) 526-737050339 Renal Dialysis 01/01/05 Garfield Kidney Center, LLC I 0 3250 W. Franklin Boulevard Chicago IL 60624 (773) 638-116050076 Renal Dialysis 01/01/05 Glendale Heights Dialysis Center I 0 520 E. North Avenue Glendale Heights IL 60139 (630) 858-8025

689 Renal Dialysis 01/01/05 Glenview Dialysis Center I 0 4248 Commercial Way Glenview IL 60025 (847) 824-200651943 Renal Dialysis 07/01/12 Grand Crossing Dialysis I 0 7319 S. Cottage Grove Avenue Chicago IL 60619-1909 (773) 783-3491 A 10/01/12

2005 Renal Dialysis 01/01/05 09/23/13 Granite City Dialysis Center I 0 9 American Village Shopping Ctr Granite City IL 62040 (618) 452-5858 C 02/01/142108 Renal Dialysis 01/01/05 Greenwood Avenue 8 Dialysis Center I 0 1111 E. 87th St Chicago IL 60619 (773) 375-5666

50625 Renal Dialysis 08/01/07 Hazel Crest Renal Center I 0 3470 W 183rd Street Hazel Crest IL 60429 (708) 799-3101 N 03/01/1358570 Renal Dialysis 11/01/13 Home Dialysis Service Elgin, LLC I 0 650 E. Terra Cotta Avenue Crystal Lake IL 60014 (779) 220-4395 A 01/01/1450570 Renal Dialysis 01/01/05 Illini Renal Dialysis I 0 507 East University Avenue Champaign IL 61820 (217) 378-7800

665 Renal Dialysis 01/01/05 Jackson Park Dialysis Center I 0 7531 S. Stony Island Chicago IL 60185 (773) 947-751050571 Renal Dialysis 01/01/05 Jacksonville Dialysis I 0 1515 West Walnut Jacksonville IL 62650 (217) 243-304251838 Renal Dialysis 12/01/11 Jerseyville Dialysis I 0 917 S. State Street Jerseyville IL 62052 (678) 498-9532 A 02/01/1251713 Renal Dialysis 08/01/10 Joliet Home Dialysis Network I 0 812 Campus Drive Joliet IL 60435 (815) 741-6830 R 05/01/1351120 Renal Dialysis 10/01/08 Kankakee County Dialysis I 0 581 William R Latham Sr Drive Bourbonnais IL 60914 (815) 936-3088 A 02/01/0951122 Renal Dialysis 10/01/08 Kennedy Home I 0 5590 N CUMBERLAND CHICAGO IL 60656 (773) 631-8296 A 05/01/09

2131 Renal Dialysis 01/01/05 Lake County Dialysis Services I 0 565 Lakeview Parkway Vernon Hills IL 60061 (847) 918-0592 AD 06/01/1351725 Renal Dialysis 03/01/11 Lake Park Dialysis I 0 1531 E. Hyde Park Boulevard Chicago IL 60615 (773) 363-9052 A 05/01/1151801 Renal Dialysis 10/01/11 Lakeview Home Dialysis LLC I 0 3023 N. Ashland Avenue Chicago Illinois 60657 (773) 525-3053 A 11/01/1150579 Renal Dialysis 01/01/05 Lakevilla Dialysis I 0 37809 N. IL Route 59 Lake Villa IL 60046 (847) 245-487251674 Renal Dialysis 12/01/10 Liberty Dialysis Hammond I 0 7214 Calumet Avenue Hammond IN 46325 (219) 228-4477 A 02/01/1150618 Renal Dialysis 01/01/05 Lincoln Dialysis I 0 2100 W. Fifth Lincoln IN 62656 (217) 782-679850572 Renal Dialysis 01/01/05 Lincoln Park Dialysis I 0 3157 N Lincoln Avenue Chicago IL 60657 (773) 348-0101


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50604 Renal Dialysis 01/01/05 Lincoln Park Pd D/b/a Skyline Home I 0 7009 W. Belmont Chicago IL 60634 (773) 637-73032003 Renal Dialysis 01/01/05 04/24/13 Lincolnland Dialysis Center I 0 1112 Center West Dr Springfield IL 62704 (217) 787-3310 C 10/01/13

50573 Renal Dialysis 01/01/05 Litchfield Dialysis I 0 915 St. Francis Way Litchfield IL 62056 (217) 324-220050559 Renal Dialysis 01/01/05 Little Village Dialysis I 0 2335 W. Cermak Road Chicago IL 60608 (773) 523-293951645 Renal Dialysis 09/01/10 Lockport Home Dialysis I 0 16626 W. 159th Street Lockport IL 60441 (815) 838-2918 A 01/01/11

683 Renal Dialysis 01/01/05 Logan Square Dialysis I 0 2659 N. Milwaukee Avenue Chicago IL 60647 (773) 276-369950621 Renal Dialysis 08/01/07 Loop Renal Center I 0 1101 S. Canal Chicago IL 60607-4901 (312) 341-9472 N 03/01/13

500 Renal Dialysis 01/01/05 Loyola University Medical Center I 0 1201 West Roosevelt Maywood IL 60153 (708) 216-9000500 Renal Dialysis 01/01/05 Loyola University Medical Center I 0 2160 S 1st Ave Maywood IL 60153 (708) 216-9000

50597 Renal Dialysis 01/01/05 Macon County Dialysis I 0 1090 West McKinley Decatur IL 62526 (217) 877-935151922 Renal Dialysis 07/01/12 Manteno Dialysis Centre, LLC I 0 One East Division Street Manteno IL 60950 (815) 937-8742 A 10/01/1250274 Renal Dialysis 01/01/05 08/12/11 Maple Avenye Kidney Center I 0 610 S. Maple Avenue Oak Park IL 60304 (708) 660-4100 CP 08/01/1155343 Renal Dialysis 04/01/14 Maple Avenye Kidney Center I 0 610 S. Maple Avenue Oak Park IL 60304 (708) 660-4100 P 05/01/1450576 Renal Dialysis 01/01/05 Marion Dialysis I 0 324 S. 4th Street Marion IL 62959 (618) 997-841050235 Renal Dialysis 01/01/05 Maryville Dialysis I 0 2130 Vadalabene Drive Maryville IL 62062 (618) 288-070351119 Renal Dialysis 10/01/08 Maryville Home Dialysis I 0 2136 B Vadalabene Drive Maryville IL 62062 (618) 288-6208 A 02/01/0950575 Renal Dialysis 01/01/05 Mattoon Dialysis I 0 200 Richmond Ave East Mattoon IL 61938 (217) 234-8468

2102 Renal Dialysis 01/01/05 11/30/12 Merilliville Dialysis Center I 0 8670 Broadway Merrillville IN 46410 (219) 791-1000 CP 02/01/1350590 Renal Dialysis 01/01/05 Merrillville Dialysis I 0 9223 Taft Merrillville IN 46410 (219) 793-903552004 Renal Dialysis 12/01/12 Merrillville Dialysis Center I 0 8670 Broadway Merrillville IN 46410 (219) 791-1000 P 02/01/1350585 Renal Dialysis 01/01/05 Metro East Dialysis I 0 5105 W. Main Belleville IL 62226 (618) 233-901851820 Renal Dialysis 07/01/11 Metropolis Dialysis Services LLC I 0 20 Hospital Drive Metropolis IL 62960 (618) 524-3046 PN 12/01/1150222 Renal Dialysis 01/01/05 Mmb Dialysis Midwest Kidney Centers, LLC I 0 523 E. Grant Street Macomb IL 61455 (309) 836-166259438 Renal Dialysis 02/01/14 Moline Home Training I 0 4650 38th Avenue Moline IL 4650 38th (309) 736-4250 A 05/01/1451953 Renal Dialysis 08/01/12 Morris Dialysis I 0 1551 Creek Drive Morris IL 60450-6857 (815) 942-3995 A 10/01/1250577 Renal Dialysis 01/01/06 Mount Vernon Dialysis I 0 4102 N. Water Tower Place Mt. Vernon IL 62864 (618) 244-3407 AD 06/01/13

38 Renal Dialysis 01/01/05 Mt Sinai Hospital Medical Center I 0 2750 W 15th Pl Chicago IL 60608 (773) 542-200050557 Renal Dialysis 01/01/05 Mt. Greenwood Dialysis I 0 3401W. 111th Street Chicago IL 60655 (773) 445-0558

647 Renal Dialysis 01/01/05 Naperville Dialysis Center I 0 100 Spaulding Drive Naperville IL 60566 (630) 717-71712141 Renal Dialysis 01/01/05 08/31/13 Neomedica – Hazel Crest I 0 17524 Carriageway Hazel Crest IL 60429 (708) 798-2899 CP 02/01/14


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2140 Renal Dialysis 01/01/05 08/31/13 Neomedica – Munster I 0 314 Ridge Road Munster IN 46321 (312) 654-2715 CP 12/01/1350063 Renal Dialysis 01/01/05 Neomedica – Roundlake I 0 401 Nippersink Round Lake IL 60073 (847) 740-5281

673 Renal Dialysis 01/01/05 08/31/13 Neomedica Bridgeport I 0 825 W. 35th Street Chicago IL 60609 (773) 890-4330 CP 12/01/13670 Renal Dialysis 01/01/05 08/31/13 Neomedica Cumberland I 0 4701 Cumberland Avenue Norridge IL 60656 (708) 456-0152 CP 12/01/13695 Renal Dialysis 01/01/05 08/31/13 Neomedica Evergreen Park I 0 9730 S. Western Avenue Evergreen Park IL 60805 (312) 654-1100 CP 12/01/13690 Renal Dialysis 01/01/05 Neomedica Gurnee I 0 101 Greenleaf Gurnee IL 60031 (312) 249-5555692 Renal Dialysis 01/01/05 08/31/13 Neomedica Hoffman Estates I 0 3150 W. Higgins Rpooad Hoffman Estates IL 60195 (847) 310-0074 CP 12/01/13649 Renal Dialysis 01/01/05 08/31/13 Neomedica Marquette Park I 0 2534 W. 69th St Chicago IL 60629 (773) 471-8525 CP 12/01/13693 Renal Dialysis 01/01/05 08/31/13 Neomedica Melrose Park I 0 1111 Superior Street Melrose Park IL 60160 (708) 338-1780 CP 12/01/13657 Renal Dialysis 01/01/05 08/31/13 Neomedica North I 0 4800 N. Kilpatrick Chicago IL 60630 (773) 545-3693 CP 12/01/13674 Renal Dialysis 01/01/05 08/31/13 Neomedica Rolling Meadows I 0 4180 Winnetka Avenue Rolling Meadows IL 60008 (847) 394-6250 CP 12/01/13668 Renal Dialysis 01/01/05 08/31/13 Neomedica South Chicago I 0 9200 S. Chicago Ave Chicago IL 60617 (773) 734-7433 CP 12/01/13694 Renal Dialysis 01/01/05 08/31/13 Neomedica South Holland I 0 17225 S. Paxton Avenue South Holland IL 60473 (708) 474-8700 CP 12/01/13642 Renal Dialysis 01/01/05 08/31/13 Neomedica South Shore I 0 2420 E. 79th Street Chicago IL 60649 (773) 374-9002 CP 12/01/13

2135 Renal Dialysis 01/01/05 Nephron Dialysis I 0 5140 N. California Chicago IL 60625 (773) 293-210015 Renal Dialysis 01/01/05 Northshore University Healthsystem I 0 2650 Ridge Avenue Evanston IL 60201-1718 (847) 570-3100 TE 08/01/13

51580 Renal Dialysis 07/13/10 11/30/12 Northwest Indiana Dialysis I 0 569 Tyler Street Gary IN 45492-1829 (219) 885-3300 CP 02/01/13651 Renal Dialysis 01/01/05 03/01/13 Oak Park Community Dialysis I 0 733 Madison Street Oak Park IL 60302 (708) 386-8757 CP 05/01/13

50583 Renal Dialysis 01/01/05 Olney Dialysis I 0 117 N. Boone Street Olney IL 62450 (618) 393-423450059 Renal Dialysis 01/01/05 Olympia Fields Dialysis Center I 0 4557 B West Lincoln Hwy Matteson IL 60443 (708) 503-111251956 Renal Dialysis 08/01/12 Palos Park Dialysis I 0 13155 S. LaGrange Road Orland Park IL 60462-1162 (708) 923-0928 A 10/01/1251673 Renal Dialysis 12/01/10 Pittsfield Dialysis I 0 640 Washington St. Pittsfield IL 62363 (217) 285-2113 A 02/01/1150655 Renal Dialysis 01/01/05 PRS, LLC I 0 9300 Ballard Road DesPlaines IL 60616 (847) 294-230850464 Renal Dialysis 01/01/05 Quad Cities Kidney Center I 0 880 Crosstown Avenue Silvis IL 61282 (309) 762-5570

675 Renal Dialysis 01/01/05 Quad Cities Kidney Center Ltd I 0 400 John Deere Rd Moline IL 61265 (309) 762-55702104 Renal Dialysis 01/01/05 Quad Cities Kidney Ctr Ltd I 0 210 W. Elk St Geneseo IL 61254 (309) 736-1579

617 Renal Dialysis 01/01/05 Quality Renal Care Llc I 0 2203 Randall Rd Carpentersville IL 60110 (847) 426-645650724 Renal Dialysis 06/01/07 Quincy Medical Group I 0 1025 Maine Street Quincy IL 62301 (217) 222-6550 A 05/01/0952011 Renal Dialysis 11/01/12 RAI Centre West Springfield I 0 1112 Centre West Drive Springfield IL 62704 (217) 787-3310 A 03/01/1352013 Renal Dialysis 11/01/12 RAI Hamacher Waterloo I 0 509 Hamacher Drive Waterloo IL 62298 (618) 939-9003 A 03/01/13


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52018 Renal Dialysis 11/01/12 RAI Lincoln Hwy Fairview Heights I 0 821 Lincoln Hwy Fairview Heights IL 62208 (618) 632-9550 A 03/01/1352017 Renal Dialysis 11/01/12 RAI North Main Breese I 0 160 N. Main Street Breeze IL 62230 (618) 526-7370 A 03/01/1350322 Renal Dialysis 01/01/05 RCG - Morris Central Illinois I 0 1401 Lakewood Dr Morris IL 60450 (815) 942-609450354 Renal Dialysis 01/01/05 RCG – Central Illinois Canton I 0 210 W. Walnut Canton IL 61520 (309) 647-073150333 Renal Dialysis 01/01/05 RCG – Central Illinois Bloomington I 0 1505 Eastland Medical Plaza Bloomington IL 61701 (309) 664-2284 AD 09/01/1350324 Renal Dialysis 01/01/05 RCG – Central Illinois Decatur Home (was#50013) I 0 1830 S. 44th Street East Peoria IL 62521 (217) 423-676050332 Renal Dialysis 01/01/05 RCG – Central Illinois East Peoria I 0 3300 N. Main East Peoria IL 61611 (309) 698-658850331 Renal Dialysis 01/01/05 RCG – Central Illinois Pekin I 0 600 S. 13th Street Pekin IL 51554 (309) 353-762950427 Renal Dialysis 01/01/05 RCG - Merrionette Park I 0 11650 S. Kedzie Merrionette Park IL 60655 (708) 389-909950145 Renal Dialysis 01/01/05 RCG - Skokie I 0 9801 Woods Drive Skokie IL 60077 (847) 581-1620 AD 06/15/1150325 Renal Dialysis 01/01/05 RCG – Spring Valley I 0 12 Wolfer Industrial Drive Spring Valley IL 61362 (815) 664-458550326 Renal Dialysis 01/01/05 RCG – Spring Valley Central Illinois I 0 804 W. Madison Street Pontiac IL 61764 (815) 844-4340

638 Renal Dialysis 01/01/05 RCG Berwyn I 0 2601 S. Harlem, 1st Floor Berwyn IL 60402 (708) 484-730051735 Renal Dialysis 04/01/11 RCG Central Illinois Bloomington Capd I 0 1404 Eastland Drive Bloomington IL 61701 (309) 664-2284 A 06/01/1150148 Renal Dialysis 01/01/05 RCG -evanston I 0 2953 Central Street, 1st Fl Evanston IL 60201 (847) 869-943650146 Renal Dialysis 01/01/05 RCG -northwestern I 0 710 N. Fairbanks Ct Chicago IL 60611 (312) 274-020250330 Renal Dialysis 01/01/05 RCG –peoria Downtown I 0 410 W. Romeo B, Garrett Ave Peoria IL 61605 (309) 637-410050327 Renal Dialysis 01/01/05 RCG –peoria North Central Illinois I 0 10405 N. Juliet Court Peoria IL 61615 (309) 243-2200

631 Renal Dialysis 01/01/05 RCG South Suburban Kidney Group I 0 2609 W. Lincoln Highway Olympia Fields IL 60461 (708) 747-005050149 Renal Dialysis 01/01/05 RCG -villa Park I 0 200 E. North Avenue Villa Park IL 60181 (630) 617-880750323 Renal Dialysis 01/01/05 RCGCI – Decatur Home I 0 302 W. Hay Street Decatur IL 62526 (217) 876-686651951 Renal Dialysis 08/01/12 Renal Center New Lenox I 0 1890 Silver Cross Boulevard New Lenox IL 60451 (815) 740-7144 A 10/01/1251952 Renal Dialysis 08/01/12 Renal Center West Joliet I 0 1051 Essington Road Joliet IL 60435-2893 (815) 729-9240 A 10/01/12

616 Renal Dialysis 01/01/05 Renal Research Institute/d/b/a Champaign Urbana I 0 1405 W. Park Urbana IL 61801 (217) 328-410051672 Renal Dialysis 12/01/10 Robinson Dialysis I 0 1215 N. Allen Street Robinson IL 62454 (618) 544-7092 A 02/01/1150267 Renal Dialysis 01/01/05 Rockford Dialysis I 0 2400 N. Rockton Ave Rockford IL 61103 (815) 971-611850584 Renal Dialysis 01/01/05 Roxbury Dialysis Center I 0 622 Roxbury Road Rockford IL 61108 (815) 397-071350574 Renal Dialysis 01/01/05 Rushville Dialysis I 0 Route 2, Box 99A Rushville IL 62681 (217) 322-265252056 Renal Dialysis 04/01/13 Satellite Dialysis Of Glenview I 0 2601 Compass Road Glenview IL 60026 (847) 832-0001 A 07/01/1350558 Renal Dialysis 01/01/05 Sauget Dialysis I 0 2061 Goose Lake Road Sauget IL 62206 (618) 332-7801


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50294 Renal Dialysis 01/01/05 Shelbyville Community Dialysis I 0 410 S. HeinleIn Drive Shelbyville IL 62565 (630) 690-464263 Renal Dialysis 01/01/05 Sherman Family Health Centers I 0 4900 South Route 31 Crystal Lake IL 60012 (847) 742-980064 Renal Dialysis 01/01/05 Silver Cross Hospital I 0 1900 Silver Cross Blvd. New Lenox IL 60451-9509 (815) 300-1100 TE

52586 Renal Dialysis 02/01/14 Silverbridge Home Training I 0 2410 Alift Lane Elgin Il 60124 (847) 289-5628 A 05/01/1450341 Renal Dialysis 01/01/05 Skyline Home Dialysis Fka Montclare Dialysis I 0 7009 Belmont Avenue Chicago IL 60634 (773) 889-605151452 Renal Dialysis 12/01/09 South Barrington Dialysis Ctr Llc I 0 33 W Higgins Road South Barrington IL 60010-9115 (847) 783-4700 A 02/01/1050627 Renal Dialysis 01/01/05 South Holland Renal Center I 0 16136 S. Park Avenue South Holland IL 60473 (708) 331-0200 PN 11/01/08

653 Renal Dialysis 01/01/05 Southside Dialysis Center I 0 7721 S. Western Avenue Chicago IL 60620 (773) 471-040050564 Renal Dialysis 01/01/05 Springfield Central Dialysis I 0 932 N. Rutledge Street Springfield IL 62702 (217) 788-368850563 Renal Dialysis 01/01/05 Springfield Montvale I 0 2930 S. Montvale Springfield IL 62704 (217) 793-278751954 Renal Dialysis 08/01/12 Springfield South Dialysis I 0 Springfield South Dialysis Springfield IL 62703-5944 (217) 528-1745 A 10/01/1252007 Renal Dialysis 12/01/12 St Margaret Mercy Dialysis Center, Llc I 0 5454 S. Hohman Avenue Hammond IN 46320 (219) 933-2089 P 02/01/13

2103 Renal Dialysis 01/01/05 11/30/12 St. Margaret Mercy Dialysis Center I 0 5454 S. Hohman Avenue Hammond IN 46320 (219) 933-2089 CP 02/01/1350578 Renal Dialysis 01/01/05 Stony Creek Dialysis I 0 9115 S. Cicero Avenue Oak Lawn IL 60453 (708) 423-030051702 Renal Dialysis 03/01/11 Stony Island Avenue I 0 8725 S. Stony Island Avenue Chicago IL 60617 (773) 221-7320 A 05/01/1150347 Renal Dialysis 01/01/05 Summit Medical Care I 0 1310 A W Eighteen Street Chicago IL 60608 (312) 491-970050366 Renal Dialysis 01/01/05 Sun Health I 0 2121 Oneida Street Joliet IL 60435 (815) 744-930050562 Renal Dialysis 01/01/05 Sycamore Dialysis Was Dekalb Dialysis I 0 2200 Gateway Drive Sycamore IL 60178 (815) 758-025050561 Renal Dialysis 01/01/05 Taylorville Dialysis I 0 901 W. Spresser Taylorville IL 62568 (217) 824-546050353 Renal Dialysis 01/01/05 The Jch Dialysis Center, Llc I 0 917 S. State Street Jerseyville IL 62552 (217) 223-840055220 Renal Dialysis 02/01/14 Timber Creek Dialysis I 0 1001 S. Annie Glidden Road DeKalb IL 60115 (815) 748-3074 A 05/01/1450582 Renal Dialysis 01/01/05 Trc Childrens Dialysis Center I 0 2611 N Halsted Chicago IL 60614 (773) 549-2010 A 08/01/1450019 Renal Dialysis 01/01/05 Tri-cities Dialysis, Llc. I 0 306 Randall Road Geneva IL 60504 (630) 851-4812

112 Renal Dialysis 01/01/05 University Of Illinois Medical Center I 0 1859 W. Taylor Chicago IL 60612 (312) 996-644452133 Renal Dialysis 10/01/13 US Renal Care Advanced Home Therapies I 0 200 E. North Avenue Villa Park IL 60181-1221 (630) 530-5237 A 11/01/1352130 Renal Dialysis 10/01/13 US Renal Care Bolingbrook I 0 396 Remington Blvd Bolingbrook IL 60440-4311 (630) 759-1943 A 11/01/1352129 Renal Dialysis 10/01/13 US Renal Care Oak Brook I 0 1201 Butterfield Road Downers Grove IL 60515-1074 (630) 968-0306 A 10/15/1352132 Renal Dialysis 10/01/13 US Renal Care Villa Park I 0 200 E North Avenue Villa Park IL 60181-1221 (630) 530-5237 A 11/01/1352131 Renal Dialysis 10/01/13 USRC Streamwood I 0 149 E. Irving Park Road Streamwood IL 60107-2950 (630) 289-2104 A 11/01/1351121 Renal Dialysis 10/01/08 Vandalia Dialysis I 0 301 Mattes Avenue Vandalia IL 62471 (618) 283-1366 A 02/01/09


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50199 Renal Dialysis 01/01/05 04/18/11 Waterloo Home Training I 0 509 Hammacher Waterloo IL 62298 (618) 939-3133 C 07/01/1151113 Renal Dialysis 10/01/08 Wayne County Dialysis I 0 303 NW 11th Street Fairfield IL 62837-1203 (618) 842-7204 A 02/01/0950701 Renal Dialysis 01/01/08 Wellbound Of Evanston I 0 8950 Gross Point Road Skokie IL 60077 (847) 965-1901 01/01/0851839 Renal Dialysis 12/01/11 West Lawn Dialysis I 0 7000 S. Pulaski Road Chicago IL 60629 (773) 284-5324 A 02/01/12

2136 Renal Dialysis 01/01/05 West Metro Dialysis Center I 0 1044 N. Mozart Street Chicago IL 60622 (773) 772-9400676 Renal Dialysis 01/01/05 West Suburban Dialysis Center I 0 518 N. Austin Blvd Oak Park IL 60302 (708) 386-5550 AD 05/16/08

2110 Renal Dialysis 01/01/05 West Suburban Kidney Services, Inc/d/b/a North I 0 911 W. North Avenue Melrose Park IL 60160 (708) 344-6122 AD 06/01/1150580 Renal Dialysis 01/01/05 Whiteside Dialysis I 0 2600 N. Locust Sterling IL 61081 (815) 626-317351703 Renal Dialysis 03/01/11 Woodlawn Dialysis I 0 5060 S. State Street Chicago IL 60609-5328 (773) 924-2149 AD, TE 08/01/1251704 Renal Dialysis 03/01/11 Woodlawn Home Dialysis I 0 5841 S. Maryland Ave Chicago IL 60637 (773) 363-9938 A 05/01/1151644 Renal Dialysis 09/01/10 Woodridge Home Dialysis I 0 7425 Janes Avenue Woodridge IL 60517 (253) 382-1855 A 01/01/1151683 Renal Dialysis 01/01/11 Yorkville Dialysis Llc I 0 1400 N. Beecher Road Yorkville IL 60560-4812 (630) 851-4812 A 03/01/11



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CodeChange

Date1045 Skilled Nursing 01/01/06 Abington of Glenview I 0.5 3901 Glenview Road Glenview IL 60025-2467 (847) 729-0000 A 01/13/06

50159 Skilled Nursing 10/01/01 Alden Des Plaines I 0.5 1221 Golf Road Des Plaines IL 60016-1213 (847) 768-1300 P 05/01/0350246 Skilled Nursing 05/01/14 Alden Estates of Barrington I 0.5 1420 S. Barrington Barrington IL 60010 (847) 382-6664 A 05/01/1451916 Skilled Nursing 05/01/14 Alden Estates of Shorewood I 0.5 710 W. Black Road Shorewood IL 60404 (815) 230-8700 A 05/01/1451211 Skilled Nursing 06/01/14 Alden Estates of Skokie Inc. I 0.5 4660 Old Orchard Road Skokie IL 60070 (847) 676-4800 A 06/01/14

939 Skilled Nursing 01/01/96 Alden Lakeland Manor I 0.5 820 West Lawrence Ave Chicago IL 60640 (312) 769-25705089 Skilled Nursing 05/22/08 Alden Northshore Rehab & Health I 0.5 5050 Touhy Ave Skokie IL 60077-3542 (847) 679-6100 R 01/01/091117 Skilled Nursing 02/01/09 Alden Nursing Center-Evanston I 0.5 2520 Gross Point Road Evanston IL 60201 (847) 328-6000 R 02/01/09

783 Skilled Nursing 06/01/14 Alden Nursing Ctr - Naperville I 0.5 1525 Oxford Ln Naperville IL 60565 (630) 983-0300 A 06/01/145090 Skilled Nursing 04/01/00 Alden Orland Park Rehab. I 0.5 16450 S. 97th Ave. Orland Park IL 60467 (708) 403-6500 A 05/12/00

714 Skilled Nursing 05/01/14 Alden Poplar Creek Rehabilitation & Hlthcare I 0.5 1545 Barrington Road Hoffman Estates IL 60194 (847) 884-0011 A 06/01/141010 Skilled Nursing 05/01/14 Alden Valley Ridge Rehabilitation & Hlthcare I 0.5 275 E Army Trail Rd Bloomingdale IL 60108 (630) 898-9616 A 06/01/14

53064 Skilled Nursing 04/01/13 Aria Post Acute Care I 0.5 4600 N Frontage Road Hillside IL 60162-1761 (847) 933-2600 A 12/01/131130 Skilled Nursing 12/14/98 09/11/13 Aria Post Acute Care I 0.5 4600 N. Frontage Road Hillside IL 60162 (708) 544-9933 C 10/01/13

733 Skilled Nursing 01/01/96 05/31/11 Ballard Nursing Center I 0.5 9300 Ballard Road Des Plaines IL 60016 (847) 294-2300 CP 08/01/115401 Skilled Nursing 08/16/00 Beacon Hill I 0.5 2044 S Finley Road Lombard IL 60148 (630) 691-5850 A 09/01/001103 Skilled Nursing 10/01/06 06/01/12 Beecher Manor Nursing Rehab I 0.5 1201 Dixie Highway Beecher IL 60401-4040 (708) 946-2600 C 06/01/12

759 Skilled Nursing 07/28/10 Bethany Terrace Nursing Centre I 0.5 8425 Waukegan Road Morton Grove IL 60053 (847) 965-8100 W 08/01/1050714 Skilled Nursing 07/01/13 Brandel Care Center I 0.5 2155 Pfingsten Road Northbrook IL 60062 (847) 480-6350 A 07/01/1350011 Skilled Nursing 01/01/96 04/01/13 Brentwood North Health Care Center I 0.5 3705 Deerfield Road Riverwoods IL 60015 (847) 947-9000 C 04/01/1351091 Skilled Nursing 09/01/08 Brentwood North Healthcare & Rehab I 0.5 3705 Deerfield Road Riverwoods IL 60015 (847) 947-9000 TE 08/01/12

1107 Skilled Nursing 12/01/12 Bronzeville Park Nursing Living I 0.5 3400 S Indiana Ave Chicago IL 60616-3841 (312) 842-5000 R 12/01/121199 Skilled Nursing 01/01/02 02/29/12 Burgess Square Healthcare Center I 0.5 5801 S. Cass Ave. Westmont IL 60559-2300 (630) 971-2645 CP 06/01/12

51871 Skilled Nursing 03/01/12 Burgess Square Healthcare Center I 0.5 5801 S. Cass Ave. Westmont IL 60559-2300 (630) 971-2645 P 06/01/1251845 Skilled Nursing 12/01/11 Care Center of Abingdon I 0.5 801 W Martin Street Abingdon IL 61410-1401 (309) 462-2356 A 01/01/1251812 Skilled Nursing 06/04/12 Carlinville Rehab and Health Care Center I 0.5 751 N. Oak Street Carlinville IL 62626 (217) 854-2511 W 06/01/12

1002 Skilled Nursing 06/27/06 Carlton At The Lake, Inc I 0.5 725 West Montrose Ave. Chicago IL 60613 (773) 929-1700 R 03/30/071151 Skilled Nursing 02/27/09 Chicagoland Methodist Senior Services I 0.5 1415 W. Foster Ave Chicago IL 60640-2288 (773) 769-5500 N 10/01/11



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50335 Skilled Nursing 03/01/08 Claremont Extended Healthcare I 0.5 150 N. Welland Road Buffalo Grove Il 60089 (847) 465-0200 R 05/01/0851778 Skilled Nursing 10/01/13 Claremont of Hanover Park I 0.5 2000 W Lake St Hanover Park IL 60133-4302 (847) 933-4600 R 10/01/13

947 Skilled Nursing 02/11/99 Clark Manor Convalescent Ctr. I 0.5 7433 N. Clark Chicago IL 60626 (773) 338-8778 R 04/01/9950507 Skilled Nursing 07/17/11 Community Convalescent Center I 0.5 1136 N. Mill Street Naperville IL 60563 (630) 355-3300 A 01/01/12

780 Skilled Nursing 01/01/96 02/01/12 Community Convalescent Center I 0.5 1136 North Mill Street Naperville IL 60563 (630) 355-3300 C 01/01/121127 Skilled Nursing 12/10/10 06/01/12 Countryside Care Center I 0.5 2330 W Galena Blvd Aurora IL 60506 (630) 896-4686 06/01/12

51927 Skilled Nursing 03/01/12 Countryside Care Center I 0.5 2330 W Galena Blvd Aurora IL 60506 (630) 896-4686 R & P 09/01/121126 Skilled Nursing 05/01/10 06/01/12 Crestwood Care Centre I 0.5 14255 S Cicero Ave Crestwood IL 60445-2154 (708) 371-0400 C 06/01/12

907 Skilled Nursing 11/01/01 06/04/13 Decatur Memorial Hospital SNF I 0.5 2300 N. Edward St. Decatur IL 62526-4163 (217) 877-8121 C 07/01/131169 Skilled Nursing 09/01/05 04/01/12 Dolton Health Care Rehab. I 0.5 14325 Blackstone Ave. Dolton IL 60416-1323 (708) 849-5000 C 04/01/12

793 Skilled Nursing 03/15/10 DuPage Convalescent Center I 0.5 400 N. County Farm Rd. Wheaton IL 60187 (630) 665-6400 R 03/01/1050054 Skilled Nursing 03/01/10 07/30/11 Elmbrook Healthcare Rehab Center I 0.5 127 W. Diversey Avenue Elmhurst IL 60126 (630) 530-5225 C 10/01/13

1047 Skilled Nursing 01/01/96 03/01/13 Elmcare/Elmhurst Mem. Hosp. - Transitional I 0.5 200 Berteau Elmhurst IL 60126 (630) 833-8200 C 03/01/13764 Skilled Nursing 01/01/96 Elmhurst Extended Care Center I 0.5 200 E. Lake Street Elmhurst IL 60126 (630) 516-5000 R 12/01/13

59048 Skilled Nursing 02/01/14 Evergreen Living and Rehab Center I 0.5 10124 S. Kedzie Ave. Evergreen Park IL 60805 (708) 907-7000 PN, TE 06/01/141195 Skilled Nursing 01/01/01 01/31/14 Evergreen Healthcare Center I 0.5 10124 S. Kedzie Ave. Evergreen Park IL 60803 (708) 636-9200 CP 06/01/141049 Skilled Nursing 01/01/96 Fairfield Mem. Hospital S.C.U. I 0.5 303 Northwest 11th Street Fairfield IL 62837 (618) 842-26111168 Skilled Nursing 02/02/99 Fairmont Care Centre I 0.5 5061 N. Pulaski Road Chicago IL 60630 (773) 604-8112 A 05/01/991084 Skilled Nursing 11/01/09 12/01/12 Fairview Baptist Home I 0.5 250 Village Drive Downers Grove IL 60516 (630) 769-6200 C 12/01/12

50114 Skilled Nursing 01/12/00 Forest Villa Nursing & Rehab. I 0.5 6840 W. Touhy Avenue Niles IL 60714-4520 (847) 647-6400785 Skilled Nursing 02/01/09 Friendship Village of Schaumburg I 0.5 350 W. Schaumburg Road Schaumburg IL 60194-3464 (847) 884-5000 N&TE 05/01/11

50220 Skilled Nursing 01/01/96 Gateway Regional Medical Center I 0.5 2100 Madison Ave. Granite City IL 62040 (618) 798-3013 PN 10/16/03954 Skilled Nursing 01/01/96 Glen Crest Nursing & Rehab. I 0.5 2451 W. Touhy Chicago IL 60645 (773) 338-6800952 Skilled Nursing 01/01/96 GlenBridge Nursing & Rehab. I 0.5 8333 W. Golf Road Niles IL 60714 (847) 966-9190

1033 Skilled Nursing 01/01/96 Glenshire Nursing & Rehab. I 0.5 22660 S. Cicero Ave. Richton Park IL 60471 (708) 747-6120974 Skilled Nursing 01/01/96 Glenview Terrace Nursing Ctr. I 0.5 1511 Greenwood Road Glenview IL 60025 (847) 729-9090710 Skilled Nursing 01/01/96 Gottlieb Mem. Hospital Extended Care I 0.5 701 W. North Ave. Melrose Park IL 60160 (708) 681-3200921 Skilled Nursing 06/01/10 Graham Hospital Extended Care I 0.5 210 W Walnut St. Canton IL 61520-2444 (309) 647-5240 A 06/01/10


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50208 Skilled Nursing 01/01/96 08/01/13 Grant Hospital (SNF) I 0.5 550 W. Webster Chicago IL 60614 (773) 883-2000 C 08/01/1350128 Skilled Nursing 02/01/09 Greek American Rehab nursing Center I 0.5 220 N. First St. Wheeling IL 60090-2980 (847) 459-8700 A 02/01/0951823 Skilled Nursing 11/01/11 Greenville Regional Hospital d/b/a Fair Oaks I 0.5 200 Healthcare Drive Greenville IL 62246-1154 (618) 664-1230 A 01/01/12

725 Skilled Nursing 07/01/02 Hammond Henry District Hosp ECF I 0.5 210 W. Elk Street Geneseo IL 61254-1067 (309) 944-6431 A 07/09/021050 Skilled Nursing 02/10/12 Harmony Nursing & Rehab. Center I 0.5 3919 W. Foster Ave. Chicago IL 60625-6056 (773) 588-9500 R 02/01/12

50414 Skilled Nursing 05/01/14 Health Resource Solutions I 0.5 1806 S. Highland Avenue Lombard IL 60148 (312) 604-3740 A 08/01/141159 Skilled Nursing 10/01/98 Heartstone at Centegra I 0.5 527 W. South Street Woodstock IL 60098 (815) 334-5077 N 09/01/13

51970 Skilled Nursing 04/01/14 Helia Healthcare of Yorkville I 0.5 1308 Game Farm Road Yorkville IL 60560 (630) 553-5811 A 05/01/14901 Skilled Nursing 01/01/96 09/10/13 Highland Park Hosp. SNF Unit I 0.5 718 Glenview Ave. Highland Park IL 60035 (847) 432-8000 C 10/01/13

51611 Skilled Nursing 01/01/14 Highland Park Nursing Rehab. Center I 0.5 50 Pleasant Ave Highwood IL 60040-1813 (847) 432-9142 A 02/01/1451038 Skilled Nursing 10/01/08 10/20/11 Holy Family Health Care Center I 0.5 2380 E. Dempster St. Des Plaines IL 60016-4839 (847) 296-3335 C 11/01/11

732 Skilled Nursing 06/01/10 Hoopeston Com. Mem. Hosp. Nursing Home I 0.5 701 E. Orange St. Hoopeston IL 60942 (217) 283-5531 A 06/01/101103 Skilled Nursing 05/01/14 Jackson Square Nursing & Rehabilitation I 0.5 5130 W. Jackson Boulevard Chicago IL 60644 (773) 921-8000 A 05/01/14

52143 Skilled Nursing 09/01/13 Lake Forest Place I 0.5 1100 Pembridge Drive Lake Forest IL 60045-4228 (847) 604-8800 A 12/01/1351902 Skilled Nursing 04/01/13 Lakeview Rehab and Nursing Center I 0.5 735 E Diversey Chicago IL 60614-2337 (773) 348-4055 A 03/01/1350387 Skilled Nursing 10/01/12 Lexington Health Care Center of Lombard I 0.5 2100 S Finley Road Lombard IL 60148-4830 (630) 495-4000 A 10/01/1250376 Skilled Nursing 01/30/12 Lexington Health Care Chicago Ridge I 0.5 10300 Southwest Hwy. Chicago Ridge IL 60415-1426 (708) 425-1100 A 10/01/1250377 Skilled Nursing 12/01/12 Lexington Health Care Elmhurst I 0.5 420 W Butterfield Road Elmhurst IL 60126-4980 (630) 832-2300 A 12/01/1250378 Skilled Nursing 09/01/12 Lexington Health Care LaGrange I 0.5 4735 Willow Springs Road LaGrange IL 60525-6130 (708) 352-6900 A 09/01/1250379 Skilled Nursing 08/01/12 Lexington Health Care Lake Zurich I 0.5 900 S Rand Road Lake Zurich IL 60047-2450 (847) 726-1200 A 07/01/1250382 Skilled Nursing 11/01/12 Lexington Health Care Orland Park I 0.5 14601 S John Humphrey Dr Orland Park IL 60462 (708) 349-8300 A 11/01/1250380 Skilled Nursing 10/01/12 Lexington Health Care Schaumburg I 0.5 675 S Roselle Road Schaumburg IL 60193-3100 (847) 352-5500 A 10/01/1250384 Skilled Nursing 11/01/12 Lexington Health Care Streamwood I 0.5 815 E Irving Park Road Streamwood IL 60107-3073 (630) 837-5300 A 11/01/1250383 Skilled Nursing 12/01/12 Lexington Health Care Wheeling I 0.5 730 W Hintz Road Wheeling IL 60090-5501 (847) 537-7474 A 12/01/1250385 Skilled Nursing 12/01/12 Lexington Healthcare Bloomingdale I 0.5 165 S. Bloomingdale Road Bloomingdale IL 60108 (630) 980-8700 A 12/01/1250734 Skilled Nursing 05/01/14 Lieberman Center for Health and I 0.5 9700 Gross Point Road Skokie IL 60076 (847) 674-7210 A 05/01/1450479 Skilled Nursing 05/01/14 LifeCare Home Health Services I 0.5 3400 Dundee Road Northbrook IL 60062 (847) 205-4444 A 05/01/14

1143 Skilled Nursing 05/01/14 Lutheran Home Services I 0.5 800 W Oakton St Arlington IL 60004 (847) 253-3710 A 05/01/14


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50721 Skilled Nursing 02/01/08 Manor Care at Arlington Heights I 0.5 715 W. Central Road Arlington Hgts IL 60005 (847) 392-2020 A 06/01/0850672 Skilled Nursing 02/01/08 Manor Care at Naperville I 0.5 200 Martin Ave. Naperville IL 60540 (630) 355-4111 P 07/01/0850685 Skilled Nursing 02/01/08 Manor Care at South Holland I 0.5 2145 E. 170th Street South Holland IL 60473 (708) 895-3255 P 08/01/0850676 Skilled Nursing 11/17/10 Manor Care Health Serv. Oak Lawn East I 0.5 9401 S. Kostner Ave. Oak Lawn IL 60453 (708) 423-7882 A 03/10/0850688 Skilled Nursing 02/01/08 Manor Care Health Services - Elk Grove I 0.5 1920 Nerge Road Elk Grove Village IL 60007 (847) 301-0550 R 11/01/1350695 Skilled Nursing 04/30/11 Manor Care Health Services - Hinsdale I 0.5 600 West Ogden Ave. Hinsdale IL 60521 (630) 325-9630 P 07/01/0850693 Skilled Nursing 02/01/08 Manor Care Health Services - Westmont I 0.5 512 E. Ogden Ave. Westmont IL 60559 (630) 323-4400 P 07/01/0850696 Skilled Nursing 03/14/12 Manor Care Health Services Elgin I 0.5 180 S. State St. Elgin IL 60123-6429 (847) 742-3310 A 03/01/1250675 Skilled Nursing 02/01/08 Manor Care Health Services Northbrook I 0.5 3300 Milwaukee Avenue Northbrook IL 60062 (847) 795-9799 R 11/01/1350674 Skilled Nursing 08/01/14 Manor Care Health Services Oak Lawn West I 0.5 6300 W. 95th Street Oak Lawn IL 60453-2256 (708) 599-8800 A 08/01/1450677 Skilled Nursing 03/18/14 Manor Care Health Services Palos Heights I 0.5 11860 Southwest Highway Palos Heights IL 60463 (708) 361-4555 A 04/01/1450689 Skilled Nursing 06/01/14 Manor Care Homewood I 0.5 940 Maple Road Homewood IL 60430 (708) 799-0244 A 08/01/1450686 Skilled Nursing 03/20/14 Manor Care of Palos Heights (East) I 0.5 7850 W College Dr Palos Heights IL 60463 (708) 361-6990 A 04/01/1450673 Skilled Nursing 06/01/14 Manor Care of Rolling Meadows I 0.5 4225 Kirchoff Road Rolling Meadows IL 60008 (847) 397-2400 A 06/01/1450679 Skilled Nursing 05/01/14 Manor Care of Wilmette I 0.5 432 Poplar Drive Wilmette IL 60091 (847) 256-5000 A 07/01/1450687 Skilled Nursing 08/11/12 Manor Health Services Libertyville I 0.5 1500 S Milwaukee Ave. Libertyville IL 60048-3723 (847) 816-3200 A 02/01/1050373 Skilled Nursing 01/01/05 MarianJoy Rehab. Hospital & Clinic I 0.5 26 W. 171 Roosevelt Rd. Wheaton IL 60187-6078 (630) 909-8000 TE 09/01/12

1110 Skilled Nursing 02/01/14 Mayfield Care Center I 0.5 5905 W Washington Blvd Chicago IL 60644 (773) 261-7074 A1110 Skilled Nursing 02/14/14 Mayfield Care Center I 0.5 5905 W Washington Blvd Chicago IL 60644 (773) 261-7074 A 08/01/14

51926 Skilled Nursing 05/01/13 McKinley Court I 0.5 500 W McKinley Ave Decatur IL 62526-3281 (217) 875-0020 A 05/01/13970 Skilled Nursing 01/01/14 Meadowbrook Manor I 0.5 431 Remington Blvd Bolingbrook IL 60440-4918 (630) 759-1112 A 02/01/14

50455 Skilled Nursing 01/01/14 Meadowbrook Manor of LaGrange I 0.5 339 S. 9th Ave. LaGrange IL 60525-6429 (630) 759-1112 A 02/02/1459900 Skilled Nursing 02/01/14 Medina Nursing Center I 0.5 402 S. Center Street Durand IL 61024 (815) 248-2151 A 05/01/1451500 Skilled Nursing 12/01/09 Mercy Harvard Care Center I 0.5 901 Grant St. Harvard IL 60033-1821 (815) 943-2961 A 03/01/10

1149 Skilled Nursing 07/01/13 Michaelsen Health Center I 0.5 831 N Batavia Ave Batavia IL 60510 (630) 879-4300 R 07/01/13778 Skilled Nursing 11/19/08 Norridge Healthcare & Nursing Center I 0.5 7001 W. Cullom Ave. Norridge IL 60634 (708) 457-0700 W 12/01/08

1083 Skilled Nursing 03/01/10 Oak Brook Healthcare Centre I 0.5 2013 Midwest Road Oak Brook IL 60523-1312 (630) 495-0220 TE 05/01/111026 Skilled Nursing 01/01/96 Oakton Pavillion, Inc. I 0.5 1660 Oakton Place Des Plaines IL 60018 (847) 299-5588


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911 Skilled Nursing 05/01/96 Our Lady of the Resurrection I 0.5 5645 W. Addison Chicago IL 60634 (773) 282-70001060 Skilled Nursing 07/28/10 P. A. Peterson Home I 0.5 1311 Parkview Ave Rockford IL 61107 (815) 399-8832 W 08/01/10

50599 Skilled Nursing 01/01/14 Park Place Christian Community I 0.5 1150 S. Euclid Avenue Elmhurst IL 60126 (630) 909-7370 A 08/01/1450317 Skilled Nursing 01/01/05 Passavant Area Hospital I 0.5 1600 W. Walnut Street Jacksonville IL 62650 (217) 245-9541 A 03/08/0550244 Skilled Nursing 06/01/14 Prairie Manor Nursing and Rehab I 0.5 345 Dixie Highway Chicago Heights IL 60411 (847) 905-3000 A 08/01/1451755 Skilled Nursing 06/01/11 Presence Ballard Nursing Center I 0.5 9300 W Ballard Road Des Plaines IL 60016-4904 (847) 478-6382 N 11/01/1351051 Skilled Nursing 11/01/12 Presence Cor Mariae Center I 0.5 3330 Maria Linden Drive Rockford IL 61114-5480 (815) 877-7416 A 11/01/1350038 Skilled Nursing 06/25/08 Presence Mary Haven Nursing and Rehab I 0.5 1700 E. Lake Ave Glenview IL 60025 (847) 729-1300 N 11/01/1351005 Skilled Nursing 10/01/08 Presence Resurrection Life Center I 0.5 7370 W. Talcott Ave Chicago IL 60631-3751 (773) 594-7400 N 11/01/13

5411 Skilled Nursing 07/29/08 Presence Resurrection Nursing and Rehab I 0.5 1001 N. Greenwood Avenue Park Ridge IL 60068 (847) 692-5600 W 08/01/086 Skilled Nursing 01/01/96 Presence Saint Mary and Elizabeth Medical I 0.5 2233 W. Division Street Chicago IL 60622-3043 (312) 770-2000 N 12/01/13

51055 Skilled Nursing 11/01/13 Presence St. Anne Center I 0.5 4405 Highcrest Road Rockford IL 61107 (815) 229-1999 A 11/01/131201 Skilled Nursing 11/01/13 Presence Villa Scalabrini Nursing and Rehab. I 0.5 480 N Wolf Road Northlake IL 60164 (708) 562-0040 R 11/01/13

975 Skilled Nursing 01/01/96 Proctor Skilled Nursing Ctr. I 0.5 5409 N. Knoxville Ave. Peoria IL 60614 (309) 691-109351053 Skilled Nursing 05/01/12 Provena Mcauley Manor I 0.5 400 W Sullivan Road Aurora IL 60506-1452 (630) 859-3700 A 05/01/12

1019 Skilled Nursing 04/01/10 Providence Healthcare and Rehab. I 0.5 3450 Saratoga Avenue Downers Grove IL 60515 (630) 969-2900 N & R 04/01/101021 Skilled Nursing 04/01/10 Providence Healthcare and Rehab. I 0.5 13259 S Central Ave Palos Hts IL 60463 (708) 597-1000 N & R 04/01/10

781 Skilled Nursing 06/01/10 Providence Healthcare Rehab. South Holland I 0.5 16300 Wausau Avenue South Holland IL 60473 (708) 596-5500 R 06/01/101196 Skilled Nursing 08/23/11 Renaissance at 87th Street I 0.5 2940 W 87th Street Chicago IL 60652-3832 (773) 434-8787 A 09/01/11

50036 Skilled Nursing 12/01/08 Renaissance at Midway I 0.5 4437 S. Cicero Ave. Chicago IL 60632-4333 (773) 884-0484 A 12/01/0850787 Skilled Nursing 05/01/14 Renaissance Park South I 0.5 10935 S. Halsted Chicago IL 60628 (773) 928-2000 A 05/01/14

1189 Skilled Nursing 01/01/10 Resenaissance At South Shore, Inc I 0.5 2425 E. 71st. St. Chicago IL 60649-2612 (773) 721-5000 A 01/01/10976 Skilled Nursing 01/01/96 Richland Memorial Hospital SNF I 0.5 800 E. Locust Street Olney IL 62450 (618) 395-2131795 Skilled Nursing 06/01/14 Rolling Hills Manor I 0.5 3615 16th Street Zion IL 60099 (847) 746-8382 A 08/01/14

50739 Skilled Nursing 04/01/09 Rosewood Care Center of Joliet I 0.5 3401 Hennepin Drive Joliet IL 60431-1080 (815) 436-5900 W 05/01/0950745 Skilled Nursing 04/01/09 Rosewood Care Center Rockford I 0.5 1660 S Mulford Road Rockford IL 61108-6760 (815) 397-8700 W 05/01/09

40 Skilled Nursing 02/01/97 Rush Oak Park Hospital I 0.5 520 S. Maple Ave. Oak Park IL 60304-1022 (708) 383-930050704 Skilled Nursing 11/29/10 02/01/11 Salem Village Nursing Home I 0.5 1314 Rowell Ave Joliet IL 60433-2866 (815) 727-5451 AC 03/01/11


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Date


1158 Skilled Nursing 10/01/98 Schwab Rehabilitation Center I 0.5 1401 S. California Ave. Chicago IL 60608-1858 (773) 522-2010 R 05/01/08955 Skilled Nursing 01/01/95 Sherman West Court I 0.5 1950 Larkin Ave Elgin IL 60123 (847) 742-7070 08/01/11934 Skilled Nursing 01/01/96 South Suburban Hosp. SNF I 0.5 17800 S. Kedzie Ave. Hazel Crest Il 60429 (708) 799-8000

1022 Skilled Nursing 01/01/96 St. Anthony's Health Center I 0.5 915 East Fifth Street Alton IL 62002-0340 (616) 463-51185407 Skilled Nursing 06/25/08 St. Benedict Nursing and Rehab I 0.5 6930 W Touhy Ave Niles IL 60714-4522 (867) 647-0003 W5410 Skilled Nursing 06/25/08 11/30/13 St. Francis Extended Care Facility I 0.5 500 Asbury Ave Evanston IL 60202 (847) 869-3600 C 01/01/14

757 Skilled Nursing 01/01/96 St. John's Hospital North Gen LTC I 0.5 800 East Carpenter Springfield IL 62702 (217) 544-64645448 Skilled Nursing 06/30/01 St. Joseph Hospital, SNF I 0.5 2900 North Lake Shore Dr. Chicago IL 60657 (773) 975-3000 PN 08/01/011156 Skilled Nursing 12/07/10 St. Mary and Elizabrth Medical Center I 0.5 2233 W. Division Chicago IL 60622-8151 (312) 770-2000 A 10/01/11

919 Skilled Nursing 01/01/96 10/01/12 St. Mary's Hosp. ECF I 0.5 111 Spring Street Streator IL 61364 (815) 673-2311 C 10/01/12967 Skilled Nursing 01/01/96 St. Vincent Mem. Hospital SNF I 0.5 201 East Pleasant Taylorville IL 62568 (217) 824-3331922 Skilled Nursing 01/01/96 Swedish Covenant Hosp. ECF I 0.5 5145 North California Ave. Chicago IL 60625 (773) 878-8200 R 08/01/08

51929 Skilled Nursing 03/01/12 Symphony of Crestwood Care Centre I 0.5 14255 S Cicero Ave Crestwood IL 60445-2154 (708) 371-0400 N 12/01/1351934 Skilled Nursing 04/01/13 Symphony of Joliet I 0.5 306 N. Larkin Ave. Joliet IL 60435 (815) 744-5560 N 12/01/1351931 Skilled Nursing 03/01/12 10/01/13 Symphony of Lincoln I 0.5 2202 N. Kickapoo St. Lincoln IL 62656 (217) 735-1538 N 10/01/13

968 Skilled Nursing 10/20/11 The Imperial Grove Pavillion I 0.5 1366 W. Fullerton Ave. Chicago IL 60614 (773) 248-9300 R 11/01/1152142 Skilled Nursing 09/01/13 The Moorings of Arlington Heights I 0.5 811 E. Central Road Arlington Hgts. IL 60005-3244 (888) 601-3027 A 12/01/1350262 Skilled Nursing 08/01/14 The Tillers Nursing & Rehab Center I 0.5 4390 Rt 71 Oswego IL 60543 (630) 554-1001 A 09/01/1458763 Skilled Nursing 09/01/13 The Villa at South Holland LLC I 0.5 16300 Wausau Ave. South Holland IL 60473-2158 (708) 596-5500 A 01/01/14

1063 Skilled Nursing 02/01/96 12/01/13 Transitional Care Center/Evanston & I 0.5 2650 Ridge Ave. Evanston IL 60201 (847) 570-2900 C 01/01/1452090 Skilled Nursing 07/01/13 VHS of Illinois d/b/a Macneal Hospital I 0.5 3249 S Oak Park Ave Berwyn IL 60402-3429 (708) 783-3002 A 09/01/1352090 Skilled Nursing 07/01/13 VHS of Illinois d/b/a/ Macneal Hospital I 0.5 3249 S Oak Park Ave Berwyn IL 60402-3429 (708) 783-3002 A 09/01/1351589 Skilled Nursing 08/01/10 VHS West Suburban Medical Center SNF I 0.5 Erie at Austin Oak Park IL 60302 (708) 363-6200 PN 08/01/1051588 Skilled Nursing 08/01/10 VHS Westlake Hospital Inc I 0.5 1225 Superior Street Melrose Park IL 60160 (708) 681-3000 PN 08/01/1051811 Skilled Nursing 06/04/12 Villa Health Care East I 0.5 100 Marian Parkway Sherman IL 62684 (217) 744-2299 W 06/01/1259146 Skilled Nursing 02/01/14 Warren Barr Living and Rehab I 0.5 66 W Oak St. Chicago IL 60610 (312) 705-5100 PN 04/01/1450189 Skilled Nursing 01/01/96 01/31/14 Warren Barr Pavilion I 0.5 66 West Oak Chicago Il 60610 (312) 337-5400 CP 04/01/14

977 Skilled Nursing 01/01/96 West Suburban Hospital I 0.5 Erie at Austin Oak Park IL 60302 (708) 363-6200


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CodeChange

Date


2100 Skilled Nursing 03/09/07 Westminster Place I 0.5 3200 Grant Street Evanston IL 60201 (847) 492-4802 N 12/01/1350368 Skilled Nursing 06/22/05 Whitehall of Deerfield I 0.5 3000 Waukegan Road Deerfield IL 60015 (847) 945-4600 PN 05/08/0650359 Skilled Nursing 07/01/13 Windsor Park Manor I 0.5 110 Windson Park Drive Carol Stream IL 60188-1986 (630) 682-4491 A 07/01/1352092 Skilled Nursing 08/01/13 Winning Wheels Inc I 0.5 701 E Third St. Prophetstown IL 61277-1334 (815) 537-5168 A 09/01/1351650 Skilled Nursing 10/01/10 Wynscape Health and Rehab. I 0.5 2180 W. Manchester Road Wheaton IL 60187-4580 (630) 665-4330 A 01/01/11




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50211 Substance Use Disorder 07/01/13 Advocate Addiction Treatment Prog X * 701 Lee Street Des Plaines IL 60016 (847) 795-3900402 Substance Use Disorder 02/01/99 Alexian Behavioral Health Hospital X * 1650 Moon Lake Blvd. Hoffman Estates IL 60007 (847) 882-1600

50396 Substance Use Disorder 11/01/13 Arlington Center for Recovery X * 1655 S Arlington Hts Rd Arlington Hgts IL 60005 (847) 427-9680 A 11/01/131818 Substance Use Disorder 11/01/13 Ben Gordon Center X * 12 Health Services Dr. Dekalb IL 60115 (817) 756-4875 A 11/01/13

50203 Substance Use Disorder 09/01/12 Care Addiction Treatment Program X * 309 Hamilton Street Geneva IL 60134-2182 (630) 402-0144 C 09/01/1351118 Substance Use Disorder 12/01/08 Center for Alcohol and Drug Services X * 4230 11th St. Rock Island IL 61201-6746 (309) 788-4571 A 10/01/1151602 Substance Use Disorder 07/01/10 Center for Alcohol and Drug Services X * 621 17th Ave. East Moline IL 61244-2036 (563) 322-2667 A 10/01/1052100 Substance Use Disorder 08/01/13 Centerpointe Hospital X * 815 East 5th St Alton IL 62002-6471 (636) 441-7300 A 10/01/13

363 Substance Use Disorder 01/01/95 Central DuPage Hospital X * 25 North Winfield Road Winfield IL 60190 (630) 933-1600552 Substance Use Disorder 11/01/13 Chestnut Health Systems Inc. X * 702 W. Chestnut St Bloomington IL 61701-2814 (309) 820-3500 A 10/01/13339 Substance Use Disorder 01/01/95 Christ Hospital X * 4440 W. 95th Street Oak Lawn IL 60453 (708) 684-1337 TE 08/01/13

51355 Substance Use Disorder 08/01/09 Confidential Care LTD X * 720 45th St. Munster IN 46321-2818 (219) 934-6410 TE 08/01/101829 Substance Use Disorder 03/01/00 Cornell Interventions X * 901 West Jackson Blvd. Chicago IL 60607 (312) 421-0817 A 03/01/091838 Substance Use Disorder 12/01/00 Families and Adolescents in Recovery Inc. X * 2010 E. Algonquin Road Schaumburg IL 60173-4185 (847) 359-5191 A 09/01/13

801 Substance Use Disorder 01/01/95 Franciscan St. Margaret Mercy Hospital X * 24 JOLIET STREET DYER IN 46311 (219) 865-2141 N 05/01/1152080 Substance Use Disorder 05/01/13 Gateway FDT Chicago River North X * 444 North Orleans St. Chicago IL 60654-8193 (312) 464-9451 A 08/01/13

557 Substance Use Disorder 12/01/10 Gateway Foundation X * 600 W. Lincoln Ave Caseyville IL 62232-1329 (618) 345-4398 TE 07/01/1351546 Substance Use Disorder 04/01/10 Gateway Foundation , Inc X * 400 Mercy Lane Aurora IL 60506 (630) 966-7400 TE 07/01/1351547 Substance Use Disorder 04/01/10 Gateway Foundation Carbondale X * 1080 E Park St. Carbondale IL 62901 (618) 529-1151 TE 07/01/1351543 Substance Use Disorder 04/01/10 Gateway Foundation Inc X * 25480 W. Cedar Crest Lane Lake Villa IL 60506 (847) 356-8205 TE 07/01/1351542 Substance Use Disorder 04/01/10 Gateway Foundation Inc. X * 3828 W. Taylor St Chicago IL 60624 (773) 826-1916 AD& TE 07/01/1351544 Substance Use Disorder 04/01/10 Gateway Foundation Inc. X * 2200 Lake Victoria Dr. Springfield IL 62703-5596 (217) 529-9266 TE 07/01/1351541 Substance Use Disorder 04/01/10 Gateway Foundation Inc. Chop NW X * 4301 W Grand Ave. Chicago IL 60651 (773) 862-2279 TE 07/01/1352078 Substance Use Disorder 05/01/13 Gateway Foundation Pekin X * 11 South Capital Pekin IL 61554-4106 (309) 346-7800 A 09/01/1351545 Substance Use Disorder 04/01/10 Gateway Foundation Swansea X * 1 Bronze Point Swansea IL 62220-1435 (618) 234-9002 N & AD 10/01/13

77 Substance Use Disorder 01/01/95 Good Samaritan Hospital - Advocate X * 3815 Highland Avenue Downers Grove IL 60515 (630) 275-5900



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1831 Substance Use Disorder 12/01/10 Haymarket Center X * 120 N. Sangamon Chicago IL 60607 (312) 226-7984 A 01/01/111814 Substance Use Disorder 11/20/97 Hazelden Chicago X * 867 N. Dearborn Street Chicago IL 60610-3310 (312) 943-35341834 Substance Use Disorder 06/08/04 Healthcare Alternative Systems, Inc. X * 2755 W. Armitage Chicago IL 60647-4244 (773) 252-3100

580 Substance Use Disorder 01/01/95 Human Service Center X * 1200 Hamilton Blvd. Peoria IL 61606-1525 (309) 671-8040 A 10/01/11569 Substance Use Disorder 11/01/13 Human Services Center X * 10257 State Route #3 Red Bud IL 62278 (618) 282-6233 A 11/01/13

25 Substance Use Disorder 01/01/96 Ingalls Memorial Hospital X * One Ingalls Drive Harvey IL 60426 (708) 333-230051620 Substance Use Disorder 09/01/10 12/01/13 K P Counseling Inc. X * 461 N. Mulford Road Rockford IL 61107-5190 (779) 368-0060 C 01/01/1451701 Substance Use Disorder 02/01/11 Kingdom Living Outreach Serv. Inc X * 20303 S. Crawford Ave. Olympia Fields IL 60461 (708) 747-9399 A 04/01/11

497 Substance Use Disorder 01/01/95 Linden Oaks Hospital X * 852 West Street Naperville IL 60540 (630) 305-5500593 Substance Use Disorder 11/01/13 Lutheran Social Services of IL Behav. X * 675 Varsity Drive Elgin IL 60120 (847) 741-2600 A 11/01/13

52125 Substance Use Disorder 09/01/13 Maryville Residential Treatment Center X * 1150 N River Road Des Plaines IL 60016-1214 (847) 768-5373 A 11/01/1351944 Substance Use Disorder 09/01/12 New Hope Recovery Center X * 2835 N. Sheffield Chicago IL 60657 (773) 883-3916 A 09/01/13

15 Substance Use Disorder 01/01/95 NorthShore University Health System X * 2650 Ridge Avenue Evanston IL 60201-1718 (847) 570-3100 N 10/01/08334 Substance Use Disorder 01/01/95 Northwest Community Hospital X * 800 W. Central Rd. Arlington Hgts IL 60005 (847) 618-1000

51689 Substance Use Disorder 02/01/11 11/30/13 Northwestern Lake Counseling X * 17 W Grand Ave. Fox Lake IL 60020-1209 (847) 587-8400 CA 01/01/1451751 Substance Use Disorder 04/01/11 Pillars Commnity Service X * 8020 W. 87th St. Hickory Hills IL 60457-1189 (708) 745-5277 A 08/01/1151753 Substance Use Disorder 04/01/11 Pillars Community Service X * 333 N LaGrange Road LaGrange Park IL 60526-5646 (708) 745-7211 A 08/01/11

607 Substance Use Disorder 11/22/10 Prairie Center for Sub. Abuse X * 718 W Killarney Urban IL 61801 (217) 328-4500 A 12/01/10340 Substance Use Disorder 01/01/95 Presence Holy Family Medical Center X * 100 N. River Road DesPlaines IL 60016 (847) 813-3841 N 10/01/13

50595 Substance Use Disorder 05/01/07 Presence Resurrection Behavioral Health X * 2001 Butterfield Road Downers Grove IL 60515 (847) 493-3600 N & TE 08/01/13415 Substance Use Disorder 01/01/95 Presence St. Joseph Hospital X * 2900 North Lake Shore Dr. Chicago IL 60657 (773) 665-3000 N 10/01/13117 Substance Use Disorder 01/01/95 Proctor Community X * 5409 North Knoxville Ave. Peoria IL 61614 (309) 691-1000 A 09/01/13564 Substance Use Disorder 11/01/13 Project Coat X * 9730 S. Western Avenue Evergreen IL 60805 (708) 425-3000 A 11/01/13

51625 Substance Use Disorder 09/01/10 Radius Foundation Inc. X * 11952 S Harlem Ave Palos Heights IL 60463 (708) 923-0800 A 10/01/1152089 Substance Use Disorder 07/01/13 Restore Counseling & Recovery Inc. X * 7210 E State St. Rockford IL 61108-2622 (815) 708-7392 A 09/01/1353648 Substance Use Disorder 03/01/14 Rosecrance Belvidere Clinic X * 915 Alexandra Drive Belvidere IL 61008 (888) 928-5278 A 05/01/14


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53591 Substance Use Disorder 03/01/14 Rosecrance Crystal Lake X * 422 Tracy Court Crystal Lake IL 60014 (815) 363-6132 A 05/01/1452087 Substance Use Disorder 07/01/13 Rosecrance Frankfort Office X * 20635 Abbey Woods Ct North Frankfort IL 60423-3181 (815) 387-5600 A 08/01/1352084 Substance Use Disorder 07/01/13 Rosecrance Greendale House X * Rosecrance Greendale House Rockford IL 61109-1575 (815) 391-4095 A 08/01/1350292 Substance Use Disorder 07/01/11 Rosecrance Griffin Williamson X * 1601 University Dr. Rockford IL 61107-5317 (815) 391-1000 PN 07/01/1350052 Substance Use Disorder 07/01/11 Rosecrance Harrison Campus X * 3815 Harrison Avenue Rockford IL 61108 (815) 391-1000 PN 07/01/1352085 Substance Use Disorder 07/01/13 Rosecrance Marlowe House X * 1365 University Dr. Rockford IL 61107-5319 (815) 229-9190 A 08/01/1351987 Substance Use Disorder 07/01/12 Rosecrance McHenry County X * 4501 Prime Parkway McHenry IL 60050-8350 (815) 363-6132 AD 02/01/1452124 Substance Use Disorder 09/01/13 Rosecrance Naperville Office X * 608 Washington St. Naperville IL 60540 (815) 387-5600 A 11/01/1352121 Substance Use Disorder 09/01/13 Rosecrance Northbrook Office X * 1200 Shermer Road Northbrook IL 60062 (815) 387-5600 A 11/01/1352123 Substance Use Disorder 09/01/13 Rosecrance Oak Park Office X * 120 S Marion St. Oak Park IL 60302-2809 (815) 387-5600 A 11/01/1352083 Substance Use Disorder 07/01/13 Rosecrance Triage Center X * 526 W State St Rockford IL 61101-1214 (815) 387-5600 A 08/01/1351152 Substance Use Disorder 03/01/09 Serenity House Counsel Services X * 891 S Route 53 Addison IL 60101 (630) 620-7924 A 05/01/0950069 Substance Use Disorder 03/01/02 Share Program X * 1776 Moonlake Blvd. Hoffman Estates IL 60194 (847) 882-4181

64 Substance Use Disorder 01/01/95 Silver Cross Hospital X * 1900 Silver Cross Blvd. New Lenox IL 60451-9509 (815) 300-1100 TE 08/01/1251818 Substance Use Disorder 11/01/11 Soft Landing Interventions X * 1601 Bond Street Naperville IL 60563 (630) 261-9220 AD 08/01/13

561 Substance Use Disorder 05/01/10 Sojourn House, Inc. X * 565 N. Turner Ave. Freeport IL 61032 (815) 232-5121 A 06/01/10559 Substance Use Disorder 11/01/13 South Suburban Council X * 1909 Checker Square East Hazel Crest IL 60429 (708) 957-2854559 Substance Use Disorder 11/01/13 South Suburban Council on Alcohol X * 1901 Checker Square East Hazel Crest IL 60429 (708) 957-2854 A 11/01/13248 Substance Use Disorder 01/01/97 St. Elizabeth's Hospital X * 211 S. Third Street Belleville IL 62220 (618) 234-2120576 Substance Use Disorder 01/01/95 Stepping Stones Recovery Center X * 1621 Theodore Street Joliet IL 60435 (815) 744-4555

1821 Substance Use Disorder 06/01/99 The Advantage Group X * 400 Haber Road Cary IL 60013 (815) 444-6400

51895 Substance Use Disorder 04/01/12The Child, Adolescent and Family Recovery Center, LLC X * 900 North Shore Dr. Lake Bluff IL 60044 (847) 457-6730 A 05/01/12

51921 Substance Use Disorder 07/01/12 The Way Back Inn X * 1915 West Roosevelt Road Broadview IL 60155-2925 (708) 344-3301 A 09/01/12579 Substance Use Disorder 03/25/11 The Wells Center X * 1300 Lincoln Avenue Jacksonville IL 62650-3112 (217) 243-1871 A 04/01/11

50012 Substance Use Disorder 08/01/01 Therapeutic Interventions Inc. X * 1545 Hicks Road Rolling Meadows IL 60008-1222 (847) 991-4800 C 12/01/13


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51946 Substance Use Disorder 11/01/12 Timberline Knolls X * 40 Timberline Lemont IL 60439 (630) 257-9600 N 04/01/141822 Substance Use Disorder 09/01/10 Triangle Center X * 120 N. 11th Springfield IL 62703 (217) 544-9858

51588 Substance Use Disorder 08/01/10 VHS Westlake Hospital Inc X * 1225 SUPERIOR STREET MELROSE PARK IL 60160 (708) 681-3000 PN 08/01/1050713 Substance Use Disorder 04/01/08 Weckler and Associates Ltd X * 68 Ambrogio Dr. Gurnee IL 60031 (847) 662-5588 A 07/01/08

A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association*Day charge depends on the type of utilization


Rev. 08-2014

hmo illinois, blue advantage hmo and blue precision ...50356 surgicenter 04/01/05 center for...

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